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Fillable Printable Form 4343 - Missouri Department Of Revenue

Fillable Printable Form 4343 - Missouri Department Of Revenue

Form 4343 - Missouri Department Of Revenue

Form 4343 - Missouri Department Of Revenue

Mail to:Taxation Division Phone:(573) 751-5772
P.O. Box 3320 Fax:(573) 522-1720
Jefferson City, MO 65105-3320 E-mail:excise@dor.mo.gov
Form 4343 (Revised 03-2014)
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Invoice NumberPurchased FromAddress (City, State, Zip)
Manufacturer’s Invoice Price
(Before Discounts and Deals)
Total — Enter on Line 1 of the Other Tobacco Products Summary First Sale Retailers Monthly Report of Purchases Form 4341 or,
if necessary, continue on Page 2 (reverse) of this form..........................................................$
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Invoice Date
(MM/DD/YYYY)
Company License Number Month Year
Address City State Zip Code
Form
4343
Missouri Department of Revenue
Other Tobacco Products Receipts Schedule
Retailer Purchases From Unlicensed Out-of-State Suppliers
Visit //dor.mo.gov/business/tobacco/
for more information.
Reset Form
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Invoice Number
Purchased From
Address (City, State, Zip)
Manufacturer’s Invoice Price
(Before Discounts and Deals)
Total — (Lines 1 to 48 inclusive) Enter on Line 1 of the Other Tobacco Products Summary First Sale Retailers Monthly Report of
Purchases Form 4341 ...................................................................................$
$
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Invoice Date
(MM/DD/YYYY)
Enter Total from Form 4343, Page 1 ..............................................................$
Form 4343 (Revised 03-2014)
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