Form 266 (Schedule A) - Cigarette Receipts From Manufacturers Or Importers

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WHOLESALER
MISSOURI DEPARTMENT OF REVENUE
FORM
TAXATION DIVISION
MONTH OF
266
P.O. BOX 811, JEFFERSON CITY, MO 65105-0811
, 20
SCHEDULE A — CIGARETTE RECEIPTS
(REV. 04-2011)
PAGE
OF
FROM MANUFACTURERS OR IMPORTERS
INSTRUCTIONS: LIST ALL SHIPMENTS RECEIVED DURING THE CALENDAR MONTH.
If you have questions or need assistance in completing this form, please call (573) 751-7163 (TDD 1-800-735-2966) or e-mail excise@dor.mo.gov.
You may also access this form from the Department’s web site:
CHECK THE TYPE OF PACKS YOU WILL REPORT ON THIS SCHEDULE — ONE TYPE ON A SCHEDULE.
TWENTY PACKS
TWENTY-FIVE PACKS
NUMBER OF PACKAGES
DATE
INVOICE
*SPECIFY FROM
LIGGETT
PHILIP
RECEIVED
NUMBER
P. LORILLARD
R.J. REYNOLDS
OTHERS*
WHOM PURCHASED
AND MYERS
MORRIS
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
__ __ / __ __ / __ __ __ __
TOTAL (THIS PAGE)
1. SUBTOTAL — CIGARETTES
0
0
0
0
0
0
PURCHASED (THIS PAGE)
TOTAL (ALL PAGES)
2. TOTAL CIGARETTES
PURCHASED (ALL PAGES)
PROMOTIONAL CIGARETTES RECEIVED FROM MANUFACTURERS
3. SUBTOTAL—PROMOTIONAL CIGARETTES
TOTAL (THIS PAGE)
0
0
0
0
0
0
RECEIVED (THIS PAGE)
TOTAL (ALL PAGES)
4. TOTAL—PROMOTIONAL CIGARETTES
RECEIVED (ALL PAGES)
This publication is available upon request in alternative accessible format(s).
MO 860-1420 (04-2011)

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