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0 Firm Name Date Address Registration Number City, State, Zip Code Distributor Number Reason For Refund: The above firm has returned to the manufacturer packages of cigarettes with Washington State cigarette tax stamps affixed. These cigarettes were returned because they were unfit for sale. Name of Manufacturer Distributors with their own Certificate of Destroyed Goods see page 2. An authorized agent of the Department of Revenue has verified improperly stamped packages of cigarettes.
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