Form 69-108 - Texas Distributor Receiving Record Of Cigarettes
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1
269-108
PRINT FORM
CLEAR FORM
(Rev.7-09/3)
b.
TEXAS DISTRIBUTOR RECEIVING RECORD OF CIGARETTES
(Attach this form to your Texas Distributor Monthly Report of Cigarettes and Stamps, Form 69-100, for the same filing period.)
a. Taxpayer number
c. Filing period
Month ending _______________________________
d. Taxpayer name
e. Physical address of permitted location (Street)
City
State
ZIP Code
1.
2.
3.
4.
NO. of CIGARETTES
MANUFACTURER, IMPORTER, OR
RECEIVED
INVOICE
SUPPLIER’S NAME
DATE
NUMBER
20’s
25’s
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Parent category: Financial