Schedule B (Form 4389) - Tobacco Products - Other Than Cigarettes Customer Returns To Inventory

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MISSOURI DEPARTMENT OF REVENUE
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TAXATION DIVISION
FORM
P.O. BOX 3320, JEFFERSON CITY, MO 65105-3320
4389
TOBACCO PRODUCTS —
OTHER THAN CIGARETTES
(REV. 02-2012)
CUSTOMER RETURNS TO INVENTORY — SCHEDULE B
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:
DATE RETURNED
CREDIT/REFUND
CREDIT/REFUND
FROM WHOM RETURNED
MANUFACTURER’S INVOICE PRICE
INTO STOCK
NUMBER
DATE
(NAME AND ADDRESS)
(BEFORE DISCOUNTS AND/OR DEALS)
$
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0
Enter total here and on Line 3 of Form 4387 or, if necessary, continue on page 2 (reverse side) of this form . .
$
4389 (02-2012)

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