Schedule A - Report Of Cigarettes Received

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Schedule A—Report of Cigarettes Received
Clear Form
File with your Cigarette Distributor Quarterly Reconciliation Report
Distributor
License number
Business ID number (BIN)
Quarter ending
Column A
Column B
Column C
List all manufacturers and suppliers who supplied cigarettes to you for distribution
Number of
Number of
Total
cigarettes
cigarettes
Date
Manufacturer or supplier
Invoice number
20-pack
25-pack
150-105-053 (Rev. 02-11)
TOTALS
(all columns)
Attach additional schedules if needed.
Please retain a copy of each schedule for your records.
Carry totals from all columns to the Quarterly Reconciliation Report, Part 1, line 2.

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