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Get Wyoming Cigarette And Roll Your Own Tobacco Wholesale Report Form

STATE OF WYOMING CIGARETTE AND ROLL-YOUR-OWN TOBACCO WHOLESALER REPORT DUE THE 20TH OF EACH MONTH FOLLOWING THE MONTH OF SALES Mail the completed Wholesaler Report to Office of the Attorney General Tobacco Settlement Unit 123 State Capital Cheyenne WY 82002 Or fax to 307-777-7956 WHOLESALER INFORMATION Please Print or Type all information Wholesale Name Mailing Address City State Zip Location Address if different Telephone Number Facsimile Number E-mail Address Website Address es Wholesaler License Report for month of sales PARTICIPATING MANUFACTURER SALES This section is for Participating Manufacturer information only. Report only the stick count for packages you have stamped or RYO on which you have paid excise tax. Brand listing for participating manufacturers is not required only the total volume amount. The Directory is the source for identifying participating manufacturers. The Directory can be found at http //attorneygeneral*state. wy. us/tsu/FinalDirectory. pdf Please report the total number of cigarettes and roll-your-own ounces for all participating manufacturer brands. Cigarettes Roll-Your-Own Ounces Version 2012/08 NON-PARTCIPATING MANUFACTURER SALES A. STAMPED PRODUCT This table is for reporting the stick count for packages you have stamped or RYO on which you have paid excise tax for Non-Participating Manufacturers. The Directory is the source for identifying non-participating manufacturers. The Directory can be found at http //attorneygeneral*state. wy. us/tsu/FinalDirectory. pdf Name of Direct Supplier Full Street Address City State or Country Brand Sold Number of individual cigarettes Ounces of RollYour-Own Tobacco B. UNSTAMPED PRODUCT Non-Participating Manufacturers. Please call 307-777-5833 if you have any questions regarding this form or email to Lesley. osen wyo. gov* SIGNATURE AND DATE I certify under penalty of perjury that the above information is true accurate and complete. Name of wholesaler representative and title Please print or type name Wholesaler representative signature Date. Report only the stick count for packages you have stamped or RYO on which you have paid excise tax. Brand listing for participating manufacturers is not required only the total volume amount. The Directory is the source for identifying participating manufacturers. Brand listing for participating manufacturers is not required only the total volume amount. The Directory is the source for identifying participating manufacturers. The Directory can be found at http //attorneygeneral*state. wy. us/tsu/FinalDirectory. pdf Please report the total number of cigarettes and roll-your-own ounces for all participating manufacturer brands. The Directory can be found at http //attorneygeneral*state. wy. us/tsu/FinalDirectory. pdf Please report the total number of cigarettes and roll-your-own ounces for all participating manufacturer brands. Cigarettes Roll-Your-Own Ounces Version 2012/08 NON-PARTCIPATING MANUFACTURER SALES A. STAMPED PRODUCT This table is for reporting the stick count for packages you have stamped or RYO on which you have paid excise tax for Non-Participating Manufacturers.

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