Schedule E - Part I - Roll-Your-Own Tobacco Purchased, Acquired, Or Shipped Into Connecticut During The Month

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Department of Revenue Services
Schedule E - Part I
State of Connecticut
Excise/Public Services Taxes Subdivision
Roll-Your-Own Tobacco
Purchased, Acquired, or Shipped Into Connecticut During the Month
(Rev. 10/08)
Read instructions for Part I and II carefully.
You must complete Schedule E each month unless you check the appropriate box on Form OP-300, Tobacco Products Tax Return. Because you may only lawfully purchase and sell roll-your-own
tobacco in brand families listed in the Connecticut Tobacco Directory, check the most recent update of the Connecticut Tobacco Directory and any email notifications from Department of Revenue Services
(DRS) before purchasing and selling any roll-your-own tobacco and for an identification of a tobacco product manufacturer as either a participating manufacturer or a nonparticipating manufacturer. See
Informational Publication 2006(31), Licensed Tobacco Products Distributor’s Guide to Connecticut Tobacco Products Tax Laws and Other Tobacco Products-Related Laws, for more information.
Distributor’s name ________________________________________________________________ Connecticut Tax Registration Number _____________________________________
Distributor’s address ______________________________________________________________ Month of _______________________________________ Year __________________
Part I - Roll-Your-Own Tobacco Purchased Directly From Participating Manufacturer
Report in Part I the total weight of roll-your-own tobacco that you purchased (or had shipped to you in Connecticut) during the month and that you purchased directly from a participating manufacturer; the
name, address, and Federal Employer Identification Number (FEIN) of the participating manufacturer; and the brand families of the roll-your-own tobacco. Complete all columns. Attach additional sheets if
necessary.
Participating
Roll-your-own tobacco
Participating manufacturer’s name and address
Total weight
manufacturer’s FEIN
Net weight of each
brand family
Quantity
Line 1. Subtotal for this page
........................................................................................................................................................................................ 1
Line 2. Total from attached Schedule E, Part I, Additional Sheet(s). Number of additional sheet(s) _______________. ...............................................
2
Line 3. Total Part I: Add Line 1 and Line 2. .................................................................................................................................................................... 3
Line 4. Total from Part II, Subpart A, Line 3 ..................................................................................................................................................................... 4
Line 5. Total from Part II, Subpart B, Line 3 ...................................................................................................................................................................... 5
Line 6. Total weight of roll-your-own tobacco: Add Lines 3, 4, and 5. ............................................................................................................................. 6

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