Form 69-110 - Texas Distributor Report Of Interstate Sales Of Cigarettes
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269-110
PRINT FORM
CLEAR FORM
(Rev.8-09/6)
b.
TEXAS DISTRIBUTOR REPORT OF INTERSTATE SALES OF CIGARETTES - PRIOR TO 09/01/09
(Attach this form to your Texas Distributor Monthly Report of Cigarettes and Stamps, Form 69-100, for the same filing period.)
a. Taxpayer number
c. Filing period
Month ending _______________________________
d. Taxpayer name
e. Physical address of permitted location (Street)
City
State
ZIP Code
f.
STATE OF SALE(S):
1.
2.
3.
4.
5.
NO. of CIGARETTES
PURCHASER’S
INVOICE
INVOICE
INVOICE
NAME AND ADDRESS
DATE
NUMBER
TOTAL
20’s
25’s
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Parent category: Financial