Form Cig 96 - Report Of Cigarettes Sold To Other Ohio Licensed Wholesalers
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1CIG 96
hio
Department of
Rev. 3/09
Reset Form
Taxation
P.O. Box 530
Columbus, OH 43216-0530
Report of Cigarettes Sold to
Other Ohio Licensed Wholesalers
Name
Month/year
Street address
FEIN
City
State
ZIP code
Ohio’s wholesale account number
Columns
1. Date of shipment or transfer to purchasing wholesaler.
4. Enter consent number obtained from the Ohio Department of Taxation.
2. Indicate how shipped: DT, Distr Truck; CC, Common Carrier; PP, Parcel Post; CT,
5. Indicate “S” for stamped or “U” for unstamped.
Customer Truck.
6. Complete name and account number of company or person to whom cigarettes were sold.
3. Invoice number of product shipped to another wholesaler.
7. Number of sticks sold to purchasing wholesaler.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Stamped or
Date
How
Invoice
Consent
Name and Account Number of Purchasing Wholesaler
# of Sticks Sold to
Shipped
Number
Number
Unstamped
Purchasing Wholesaler
Subtotal: This page only
Mail original to Ohio Department of Taxation, Excise Tax Section, P.O. Box 530, Columbus, OH
43216-0530. Retain additional copy for your fi les.
Grand total
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