Form Rc-25 - Cigarette Importation Report - 2010

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Illinois Department of Revenue
RC-25
Cigarette Importation Report
Step 1: Identify your business
1
2
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
For what period are you filing this report?
___ ___/___ ___ ___ ___
Month
Year
License no.: ___ - ___ ___ ___ ___ ___
3
Is this an amended report?
yes
no
Business name ____________________________________________________
4
Check here if your address has changed
Address __________________________________________________________
or you have made changes to the label.
Number and street
__________________________________________________________________
City
State
ZIP
Step 2: List the brand and brand styles of the imported cigarettes
Brand:
Brand styles:
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Step 3: Sign below
Under penalties of perjury, I state that I have examined this report and all attachments and, to the best of my knowledge, it is true, correct, and com-
plete. I also state that such information is taken from the books and records of the business for which this report is filed.
__________________________________________________
_________________________________________________
Distributor’s signature
Printed name of the person who signed this report
_________________________
(_____)_____ - _____________
___ ___/___ ___/___ ___ ___ ___
Title of the person who signed above Month Day Year Telephone number
Note:
Do not send any payment with this report.
*090901110*
RC-25 front (R-04/10)
This form is authorized by the Cigarette Tax and Cigarette Use Tax Acts. Disclosure of this information is REQUIRED. Failure
to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-4126
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