Schedule Ca - Cigarettes Imported For Sale With No Il Cigarette Revenue Stamps Affixed To Original Packages

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Illinois Department of Revenue
Schedule CA
Cigarettes Imported for Sale with
No IL Cigarette Revenue Stamps
Cigarette Tax
Affixed to Original Packages
Read this information first
Sheet no. __________
Attach one copy of this schedule to Form RC-6, Cigarette Revenue Return, and retain one copy.
Additional instructions are printed on the back of Form RC-6.
Step 1: Identify your business
Name_____________________________________________
Illinois business tax (IBT) no. __ __ __ __ - __ __ __ __
Address___________________________________________
License no. ________________________________________
Number and street
__________________________________________________
Tax period __ __ / __ __ __ __
City
State
ZIP
Month
Year
Step 2: Identify your purchases
Date
Invoice no.
Purchased from name
Purchased from address
Number of cigarettes
,
,
,
_ _/_ _/_ _ _ _
________________
___________________________
____________________________________
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,
,
,
_ _/_ _/_ _ _ _
________________
___________________________
____________________________________
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_ _/_ _/_ _ _ _
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___________________________
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___________________________
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___________________________
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___________________________
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___________________________
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___________________________
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Page total
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,
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Grand total
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_____
This form is authorized as outlined by the Illinois Cigarette Tax Act. Disclosure of this information is REQUIRED. Failure to provide
SOY-BASED INK
information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-1504
RC-7 (R-6/99)
RECYCLED PAPER

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