Schedule E (Form Otp 11) - Other Tobacco Products

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OTP 11
Rev. 4/09
Reset Form
P.O. Box 530
Columbus, OH 43216-0530
Other Tobacco Products Schedule E
(Use additional pages if necessary)
Account number
Name of reporting in-state licensed distributor
Purchases of Tax-Paid Other Tobacco Products
For the period of
Page
of
Invoice
Invoice
Consent
Seller’s Name/
Invoice
Number
Date
Number
Account Number
Cost
Page total
Grand total

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