Schedule A-4 - Tobacco Products Tax - Nonresident Distributor
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1SCHEDULE A-4
SCHEDULE A-4
SCHEDULE A-4
SCHEDULE A-4
SCHEDULE A-4
STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
TOBACCO PRODUCTS TAX - NONRESIDENT DISTRIBUTOR
Record of snuff tobacco products imported into Connecticut
(Rev. 07/00)
(Total of Schedule A-4 must be reported on Line 9 of Form OP-300, Tobacco Products Tax Return )
Schedule A-4 must be attached to Form OP-300
Name ___________________________________________________
Period Ending __________________
CT Tax Registration Number _________________________
Address __________________________________________________________________________________________________________________________________________
Weight Each
Total Weight
Tax
Invoice Number
Date
Imported To
Brand Name
Quantity
(in ounces)
(Col. 5x6)
(Col. 7 x 0.40)
1
2
3
4
5
6
7
8
Total must be carried forward to Line 9 of Form OP-300
TOTAL
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