Schedule C (Form 4390) - Tobacco Products - Other Than Cigarettes Wholesaler Export Sales

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EXPORTS TO STATE OF
MISSOURI DEPARTMENT OF REVENUE
TAXATION DIVISION
FORM
P.O. BOX 3320, JEFFERSON CITY, MO 65105-3320
4390
TOBACCO PRODUCTS —
OTHER THAN CIGARETTES
(REV. 02-2012)
WHOLESALER EXPORT SALES — SCHEDULE C
COMPANY
LICENSE NO.
ADDRESS
CITY
STATE
ZIP CODE
___ ___ ___ ___ ___
If you have questions or need assistance in completing this form, please call (573) 751-5772 (TDD 1-800-735-2966)
or e-mail excise@dor.mo.gov. You may also access this form from the Department’s web site:
SALES MADE TO PERSONS OUTSIDE THE STATE OF MISSOURI — COMPLETE A SEPARATE SCHEDULE FOR
EACH STATE TO WHICH PRODUCT IS EXPORTED. PLEASE SUBMIT TWO (2) COPIES OF EACH STATE’S SCHEDULE.
YOUR
YOUR
MANUFACTURER’S INVOICE PRICE
TO WHOM SOLD
ADDRESS
INVOICE DATE
INVOICE NUMBER
(BEFORE DISCOUNTS AND/OR DEALS)
$
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0
Enter total here and on Line 7 of Form 4387 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
FORM 4390 (02-2012)

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