Form Ctx-R - Resident Agent'S Cigarette Tax Return

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FOR DEPARTMENT USE ONLY
NYC DEPARTMENT OF FINANCE ENFORCEMENT DIVISION
L.
C
HECKED BY
CTX-R
R E S I D E N T A G E N T ’ S
D
F I N A N C E
ATE
NEW YORK
R
C I G A R E T T E T A X R E T U R N
EMARKS
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
Complete this return if you are an agent located within the City of New York. This return must be received with the required support-
ing Cigarette Tax schedule attached, within 15 days after the reporting period (month and year) indicated in Section I, Item 2.
SECTION I - AGENT INFORMATION
1. Name:
2. Reporting Period.
Month and Year: __________________ 20________
3. Street Address:
City:
State:
Zip Code:
4. E-mail Address:
5. Employer Identification Number:
6. NY State License Number:
A J
7. NY City License Number:
SECTION II - REPORT OF UNSTAMPED AND NEW YORK STATE STAMPED CIGARETTES
Indicate the amounts of numbers 1-10 in the appropriate column.
NUMBER OF INDIVIDUAL CIGARETTES
Enter the number and size of odd size packages in the miscellaneous column.
Packing Size
Packing Size
Packing Size
.
MISC
Example: 5’
, 24’
, 100’
, 240’
.
S
S
S
S ETC
10
20
25
SIZE
NO
1. Inventory of unstamped cigarettes at beginning of the month ...............................
2. Number of cigarettes manufactured, purchased or
otherwise acquired (Cigarette Tax Schedule, Section II-A)....................................
3. Total(s) (Add Lines 1 and 2) ...................................................................................
4. Sales made to exempt agencies. (Cigarette Tax Schedule, Section II-B) .............
5. Sales delivered and transfer(s) made to points outside the
State of New York. (Cigarette Tax Schedule, Schedule II-C) .................................
6. Sales delivered and transfer(s) made to points outside the
City but within the State of New York. (Cigarette Tax Schedule, Section II-D) ......
7. Sales delivered and transfer(s) made to other dealers within
the City. (Cigarette Tax Schedule, Section II E) .....................................................
8. Other.......................................................................................................................
9. Inventory at end of the month ................................................................................
10. Total (Add Lines 4 through line 9) ..........................................................................
11. Balance to be accounted for (Line 3 minus Line 10) .............................................
SECTION III - REPORT OF CIGARETTE STAMPS
Use quantity, not the face value of stamps
NUMBER OF CIGARETTE STAMPS
JOINT
JOINT
JOINT
OTHER
$0.75
$1.50
$1.88
1. Inventory of unaffixed stamps at the beginning of the month ................................
2. Number of stamps purchased during the month....................................................
3. Total(s) (Add Lines 1 and 2) ..................................................................................
4. Inventory of unaffixed stamps and restamping, if any, at end of month ...............
5. Number of stamps used during the month (Line 3 minus Line 4) .................................
SECTION IV - CERTIFICATION
I, ___________________________________________________________________________________________, hereby certify that this return, together
Print Name of Owner, Partner or Corporate Officer
with the accompanying schedules or statements, have been examined by me and are to the best of my knowledge and belief, true and complete and made
in good faith, for the period stated, pursuant to Title 11, Chapter 13 of the Administrative Code and the regulations issued under authority thereof.
___________________________________________________
_____________________________________________
______________________
Signature
Title
Date
Visit Finance at nyc.gov/finance
CTX-R- 12/13/05

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