Form Com/att-601 - Wholesaler'S Affidavit Of Packages Of Cigarettes Returned To The Manufacturer With Stamps Affixed

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Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P.O. Box 2999
Annapolis, Maryland 21404-2999
Wholesaler’s Affidavit
Of Packages of Cigarettes Returned to the Manufacturer
With Stamps Affixed
Name:
License No.
Address:
This will certify that the cigarettes indicated below, with Maryland cigarette tax stamps
affixed, were returned to
on the
day of
, 20
,
via
.
(Method of Shipment)
No. Pkgs.
Stamp Denomination
Value of Stamps
The cigarettes indicated above were:
G
Returned by customers.
G
Received from manufacturer’s representative.
G
Other (describe)
I do solemnly declare and affirm under the penalties of perjury that the contents of the
foregoing document are true and correct to the best of my knowledge, information and belief.
Print Name
Signature
Title: Owner, Partner or Officer
Date
COM/ATT-601
Revised 7/07

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