Form Tob 50005 - Cigarette And Tobacco Invoice Schedule
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2TOB 50005
Cigarette and Tobacco Invoice Schedule
Revised 9-2011
Oklahoma Tax Commission
2501 North Lincoln Boulevard
Oklahoma City, OK 73194
Taxpayer FEIN
Period of Return
Cigarette License Number
____________________________________________________________________
____________________________________________________________
Firm Name
Contact Person
____________________________________________________________________
____________________________________________________________
Address
Contact Telephone Number
____________________________________________________________________
City
State
Zip
2. OTC Cigarette
8.
9.
Tobacco Permit
1. OTC Sales
6. Ship
7. Ship
Transaction
Product
(Use TR Number for
Tax Permit
3. Ship To Name
4. Ship To Address
5. Ship To City
To State
To Zip
Type
Type
Tribal Shops)
10. Invoice
11. Invoice
12. UPC
14. Pack or
15. Sell Unit
16. U/M
17. Manufacturer
Number
Date
Code
13. Description
Individual Unit Weight
Quantity
Description
Unit List Price
I, the undersigned wholesaler, distributor, jobber or duly authorized legal representative thereof do declare under the penalties of perjury that this report, including the accompanying schedules which are made a part thereof, is to the best
of my knowledge and belief true and correct.
Signature: _________________________________________________
Official Title: ___________________________________________
Date: ___________________
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