Form Com/att-027t - Cigarette Storage Warehouse Report

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Comptroller of Maryland
Revenue Administration Division
Taxpayer Services
P.O. Box 1751
Annapolis, MD 21404-1751
Phone: 410-260-7131 – Toll-Free: 888-784-0142
Fax: 410-974-3201
Cigarette Storage Warehouse Report
Name of Entity
Report Month
Storage Location
License Number
This report is a complete and accurate record of all cigarettes received and delivered for the entire month covered and is
supported by the necessary schedules. (See reverse side for instructions)
Quantity in Packs
20's
25's
1.
Total Number of Packs on hand first of month
2.
Total Number of Packs received during month
3.
Total Line 1 + 2
4.
Physical inventory on hand end of month
5.
Number of Packs disposed of or shipped during month
6.
Unaccountable Difference
7.
Total Line 4 + 5 + 6. (Must equal Line 3.)
8.
Tax Payment Submitted on Line 6 at $2.00/Pack
Statement
I certify that this report, together with attached schedules, has been examined by me and is, to the best of my knowledge
and belief, a true and complete report for the month stated.
Name of Public Storage Company
Signature
Title of Signer: Owner, Partner, Officer
Type or Print Name of Signer
COM/ATT-027T
REV. 3/11

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