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VERMONT CIGARETTE TAX STAMP ORDER
                                            VERMONT DEPARTMENT OF TAXES
                                                     133 State Street
                                                       PO Box 547
                                                Montpelier, VT 05601-0547                                 Telephone: (802) 828-6837
Name and Address of Purchaser




                                                                                COST EACH
  QUANTITY                   ITEM                 DENOMINATION                 as of 07/01/2008                EXTENDED COST
                         Rolls of 30,000              20 Cigarette                 $58,326.90              $

                          Sheets of 600               20 Cigarette                  $1,166.54              $

                          Roll of 7,200               25 Cigarette                 $17,498.07              $

                                                                     TOTALAMOUNTREMITTED                   $

                                               FOR DEPARTMENT USE ONLY
 Order filled by            Date              Received by        Date                        Date sent                  via


                                                                                                                          Form CT-3
             Price is $1.99 per pack of 20, and $2.4875 per pack of 25, minus 2.3% prepayment discount.                     Rev. 5/08




                                   VERMONT CIGARETTE TAX STAMP ORDER
                                            VERMONT DEPARTMENT OF TAXES
                                                     133 State Street
                                                       PO Box 547
                                                Montpelier, VT 05601-0547                                 Telephone: (802) 828-6837
Name and Address of Purchaser




                                                                                COST EACH
  QUANTITY                   ITEM                 DENOMINATION                 as of 07/01/2008                EXTENDED COST
                         Rolls of 30,000              20 Cigarette                 $58,326.90              $

                          Sheets of 600               20 Cigarette                  $1,166.54              $

                          Roll of 7,200               25 Cigarette                 $17,498.07              $

                                                                     TOTALAMOUNTREMITTED                   $

                                               FOR DEPARTMENT USE ONLY
 Order filled by            Date              Received by        Date                        Date sent                  via


                                                                                                                          Form CT-3
             Price is $1.99 per pack of 20, and $2.4875 per pack of 25, minus 2.3% prepayment discount.                     Rev. 5/08

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  • 1. VERMONT CIGARETTE TAX STAMP ORDER VERMONT DEPARTMENT OF TAXES 133 State Street PO Box 547 Montpelier, VT 05601-0547 Telephone: (802) 828-6837 Name and Address of Purchaser COST EACH QUANTITY ITEM DENOMINATION as of 07/01/2008 EXTENDED COST Rolls of 30,000 20 Cigarette $58,326.90 $ Sheets of 600 20 Cigarette $1,166.54 $ Roll of 7,200 25 Cigarette $17,498.07 $ TOTALAMOUNTREMITTED $ FOR DEPARTMENT USE ONLY Order filled by Date Received by Date Date sent via Form CT-3 Price is $1.99 per pack of 20, and $2.4875 per pack of 25, minus 2.3% prepayment discount. Rev. 5/08 VERMONT CIGARETTE TAX STAMP ORDER VERMONT DEPARTMENT OF TAXES 133 State Street PO Box 547 Montpelier, VT 05601-0547 Telephone: (802) 828-6837 Name and Address of Purchaser COST EACH QUANTITY ITEM DENOMINATION as of 07/01/2008 EXTENDED COST Rolls of 30,000 20 Cigarette $58,326.90 $ Sheets of 600 20 Cigarette $1,166.54 $ Roll of 7,200 25 Cigarette $17,498.07 $ TOTALAMOUNTREMITTED $ FOR DEPARTMENT USE ONLY Order filled by Date Received by Date Date sent via Form CT-3 Price is $1.99 per pack of 20, and $2.4875 per pack of 25, minus 2.3% prepayment discount. Rev. 5/08