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Get Fl Dbpr 4000a-006 2009-2024

SSEE, FL 32399-1022 REQUISITION AND INVOICE FOR CIGARETTE TAX STAMPS CASH ON DELIVERY Permit Name Phone # Address Type ( ) City Number of Indicia Permit # CHARGE (DEFERRED) Date State Net Unit Cost* Excise Amount Zip Surcharge Rate Surcharge Amount Heat 20's $0.3342 $ $1.00 $ Camel Wides $0.3342 $ $1.00 $ Heat 25's $0.41895 $ $1.25 $ $ Subtotal $ $ $ Less Credit Certificates # $ (Surcharge Credit) $ (Excise and Surcharge Credits must be taken separately) .

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