Record Type -                     Other             Amount you 
            TOB             Filing Period     Debit/Credit      owe
            TOB
                                                                Purchased From 
                                                                (name of 
            Record Type -                                       supplier or      Address (Residents leave 
            TOBTP1          Invoice Date      Invoice Number    manufacturer)    blank)
            TOBTP1
                                                                Purchased From 
                                                                (name of 
            Record Type -                                       supplier or      Address (Residents leave 
            TOBPC1          Invoice Date      Invoice Number    manufacturer)    blank)
            TOBPC1
                                                                Purchased From 
                                                                (name of 
            Record Type -                                       supplier or      Address (Residents leave 
            TOBMS1          Invoice Date      Invoice Number    manufacturer)    blank)
            TOBMS1
                                                                Manufacturer/E
                            Invoice           Invoice           xempt 
            Record Type -   Date/Credit       Number/Credit     Organization     Wholesale Sales Price on 
            TOBTP2          Date              Memo Number       Name             Tobacco
            TOBTP2
                                                                Manufacturer/E
                            Invoice           Invoice           xempt 
            Record Type -   Date/Credit       Number/Credit     Organization 
            TOBPC2          Date              Memo Number       Name             Number of Single Cigars
            TOBPC2
                                                                Manufacturer/E
                            Invoice           Invoice           xempt 
            Record Type -   Date/Credit       Number/Credit     Organization 
            TOBMS2          Date              Memo Number       Name             Number of Containers
            TOBMS2
           Record Type - 
           TOBTP3        Invoice Date    Invoice Number  Name           Address
           TOBTP3
           Record Type - 
           TOBPC3        Invoice Date    Invoice Number  Name           Address
           TOBPC3
           Record Type - 
           TOBMS3        Invoice Date    Invoice Number  Name           Address
           TOBMS3
                                                                        Wholesale 
             City (Residents    State (Residents  Zip (Residents leave  Sales Price 
             leave blank)       leave blank)      blank)                on Tobacco
             City (Residents    State (Residents  Zip (Residents leave  Number of     Wholesale Sales 
             leave blank)       leave blank)      blank)                Single Cigars Price on Cigars
                                                                                      Wholesale Sales 
             City (Residents    State (Residents  Zip (Residents leave  Number of     Price on Moist 
             leave blank)       leave blank)      blank)                Containers    Snuf
             Wholesale Sales 
             Price on Cigars
             Wholesale Sales 
             Price on Moist 
             Snuf
                                                                  Wholesale 
                                                                  Sales Price 
            City             State/Location   Zip                 on Tobacco
                                                                  Number of  Wholesale Sales 
            City             State/Location   Zip                 Single Cigars Price on Cigars
                                                                               Wholesale Sales 
                                                                  Number of  Price on Moist 
            City             State/Location   Zip                 Containers   Snuf