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Schedule C-1 Tobacco Products Tax Department of Revenue Services PO Box 5018 Hartford CT 06102-5018 (Rev 09/17) Name Period ending

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Enter the total of Schedule C-2 on line 9 of the Tobacco Products Tax Return Attach Schedule C-2 to the return Name and Address of Purchaser Column 1

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Schedule C-1

Tobacco Products Tax

Department of Revenue Services

PO Box 5018

Hartford CT 06102-5018

(Rev. 09/17) Name

Period ending

Connecticut Tax Registration Number

State of destination

Enter this amount on Form OP-300, Line 8. Total

Total Weight

(Quantity multiplied by Weight)

Quantity

Invoice

Date

Invoice

Number

Customer NameCustomer AddressCityStateZIP Code

Brand Name

Weight

Each (ounces) Enter the total of Schedule C-1 on Form OP-300, Tobacco Products Tax Return, Line 8.

Attach Schedule C-1 to Form OP-300, Tobacco Products Tax Return. Prepare a separate Schedule C-1 for each state of destination. Attach additional sheets if needed.

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