Form Ct-12 - Multiple Receipt/deduction Schedule
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4INDIANA DEPARTMENT OF REVENUE
CT-12
MULTIPLE RECEIPT/DEDUCTION SCHEDULE
SF 46857
R/ 2-02
Distributor Name ___________________________ Distributor License # ______________________
Report for the Period of _______________ , ______
Check only one (1) of the following categories
A. Purchases: Unstamped Cigarettes Imported Into Indiana
B. Purchases: Unstamped Cigarettes Purchased In Indiana
C. Purchases: Indiana Stamped Cigarettes
D. Sales: Unstamped Cigarettes Shipped To Another State
E. Sales: Unstamped Cigarettes Sold To Indiana Licensed Distributors
F.
Sales: Indiana Stamped Cigarettes Sold To Indiana Licensed Distributors
G. Sales: Indiana Stamped Cigarettes Sold Wholesale and/or Retail
H. Returned to Warehouse:
Indiana Stamped Cigarettes Returned To Warehouse
(1)
(2)
(3) PURCHASED FROM/SOLD TO
(4)
INVOICE
INVOICE
# OF
DATE
#
CIGARETTES
COMPANY NAME
COMPANY ADDRESS
PAGE TOTAL
IMPORTANT: The total figure for each schedule is to be carried forward to CT-5 or CT-24.
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