Form Tb-42 (Schedule 2) - Monthly Report Of Tobacco Products Purchases
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1KANSAS DEPARTMENT OF REVENUE
MISCELLANEOUS TAX
915 SW HARRISON ST.
TOPEKA, KANSAS 66612-1588
Web site:
Email: miscellaneous.tax@kdor.ks.gov
Phone: (785) 368-8222
Fax: (785) 291-3968
SCHEDULE 2
MONTHLY REPORT OF TOBACCO PRODUCTS PURCHASES
Name
License Number _________________________
Address
Filing Month/Year________________________
Distributor / Manufacturer
Original Manufacturer Name If
Invoice
Invoice
Manufacturer's
(circle one)
Purchased From Another
Date
Number
Net Invoice Price
Purchased From
Distributor
0.00
PAGE TOTAL
TB-42
GRAND TOTAL
(Rev. 6/13)
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