Form Tb-45 (Schedule 4) - Tobacco Products

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KANSAS DEPARTMENT OF REVENUE
MISCELLANEOUS TAX
915 SW HARRISON ST.
TOPEKA, KANSAS 66612-1588
Web site:
Email: miscellaneous.tax@kdor.ks.gov
Phone: (785) 368-8222
Fax: (785) 291-3968
SCHEDULE 4
TOBACCO PRODUCTS
r SOLD TO
________________
CUSTOMERS
CUSTOMERS
State
r
RETURNED TO MANUFACTURER*
r
SOLD TO U.S. GOVERNMENT
Name
License Number
License Number
_________________________
Address
Filing Month/Year
________________________
Invoice or
Invoice or
Manufacturer or Consignee
Manufacturer or
Manufacturer's Net
Credit Memo
Credit Memo
Name
Consignee Address
Invoice Price or
Date
Number
Credit Memo Amount
*Enclose credit memo from the manufacturer with this Schedule.
PAGE TOTAL
0.00
GRAND TOTAL
TB-45
(Rev. 6/13)

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Parent category: Financial
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