MISSOURI DEPARTMENT OF REVENUE
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TAXATION DIVISION
FORM
P.O. BOX 3320, JEFFERSON CITY, MO 65105-3320
4388
TOBACCO PRODUCTS —
OTHER THAN CIGARETTES
(REV. 02-2012)
NEW INVENTORY — SCHEDULE A
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 RECEIVED
INVOICE
INVOICE
FROM WHOM PURCHASED
MANUFACTURER’S INVOICE PRICE
INTO STOCK
NUMBER
DATE
(NAME AND ADDRESS)
(BEFORE DISCOUNTS AND/OR DEALS)
$
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4388 (02-2012)