Form Ct-11 - Cigarette Stamp Purchases Inventory Of Cigarettes And Cigarette Stamps - 1997

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Indiana Department of Revenue
P.O. Box 901
Indianapolis, IN 46206-0901
CT-11
CIGARETTE STAMP PURCHASES
SF 46856
INVENTORY OF CIGARETTES AND CIGARETTE STAMPS
Revised 7/97
For the period of ______________________, ______
Name of License Holder (as indicated on license)
Mailing Address
Cigarette Distributor’s License#
City or Town
County
State
Zip Code
Federal ID Number
PURCHASES OF CIGARETTE STAMPS
INVENTORY OF UNAFFIXED STAMPS
(1)
(2)
(3)
(4)
(5)
(6)
(1)
(2)
(3)
(4
)
Tax
Invoice
Value of
Number of
Gross
Tax
Value of
Number of
Gross
State
Date
Number
Stamp
Stamps
Value
State
Stamps
Stamps
Value
Inventory of Indiana
Inventory of Unstamped and/or
Stamped Cigarettes
Out-of -State Stamped Cigarettes
# OF CIGARETTES
(1)
(2)
(3)
# of Cigarettes
Total
# of
Per Carton
Cigarettes
Cartons
UNSTAMPED
STATE
TOTAL
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