Form Ctx-Nr - Non-Resident Agent'S Cigarette Tax Return (Page 2 of 2) in pdf

NYC DEPARTMENT OF FINANCE

ENFORCEMENT DIVISION

C I G A R E T T E T A X S C H E D U L E

F I N A N C E

NEW YORK

THE CITY OF NEW YORK

DEPARTMENT OF FINANCE

Mail to: NYC Department of Finance, Enforcement Division, Cigarette Tax Unit, 345 Adams Street, 13th Floor, Brooklyn, NY 11201

Use this form to summarize NYS stamped or unstamped cigarettes, either manufactured, purchased or otherwise acquired; NYS stamped cigarettes sold or transferred to exempt

agencies or those sold, transferred from NYC to points outside the State of New York. This tax schedule must accompany the CTX-R or CTX-NR application. See Section II.

SECTION I - AGENT INFORMATION

1. Name:

2. Reporting Period.

Month and Year: __________________ 20________

3. Street Address:

City:

State:

Zip Code:

4. E-mail

5. NY State License Number:

6. NY City License Number

Address:

A J

SECTION II - CIGARETTE SALES AND PURCHASES INFORMATION

Please indicate type of cigarette sales or purchases you are reporting by checking one of the choices below and completing the appropriate column in the table.

Check one:

Unstamped and NY State Stamped Cigarettes Manufactured, Purchased or Otherwise Acquired. Complete columns 1 and 3. (Submit with CTX-R)

Sales of Unstamped Cigarettes To Exempt Agencies Complete columns 2 and 3. (Submit with CTX-R)

Unstamped and NY State Stamped Cigarettes Sold, Transferred and Delivered from NYC to Points Outside the State of New York. Complete columns 2, 3 and 4.

(Enter total in CTX-R or CTX-NR)

Unstamped and NY State Stamped Cigarettes Sold, Transferred and Delivered from NYC to Points Outside the City but within the State of New York. Complete

columns 2, 3 and 4. (Enter total in form CTX-R) - Destination must be included. See Section III on this application.

Unstamped and NY State Stamped Cigarettes Sold, Transferred and Delivered to Other Dealers Within the City of New York. Complete columns 2 and 3. (Submit with

CTX-R and CTX-NR) - Include sales of cigarettes to dealers for resale outside the City and returns of all cigarettes to all manufacturers, and others within the City.

Number of Individual Cigarettes

Indicate if

Purchased From

Sold to Transferred or Returned

NYC

PACKING PACKING PACKING

Misc.

tax paid

SIZE

Name/Street Address City/State/Zip Code

10’s

20’s

25’s

YES or NO

Name

Street Address

City/State/Zip Code

Name

Street Address

City/State/Zip Code

Name

Street Address

City/State/Zip Code

Name

Street Address

City/State/Zip Code

Name

Street Address

City/State/Zip Code

Name

Street Address

City/State/Zip Code

Name

Street Address

City/State/Zip Code

USE ADDITIONAL SHEET(S) IF NECESSARY

TOTAL:

SECTION III - DESTINATION INFORMATION

1. If you checked “D” above, complete columns 2, 3 and 4 and indicate the city of destination in this space. Use a separate application for each city.

Destination City: _______________________________________________________________________________________________________________

Visit Finance at nyc.gov/finance

CTX-sched 09/06/05