Department of Revenue Services
Form CT-40
State of Connecticut
File in Duplicate
Excise/Public Services Taxes Subdivision
Schedule C-2
25 Sigourney Street
Hartford CT 06106-5032
Sales and Transfers of
Rev. 12/01
Connecticut Stamped Cigarettes Outside of Connecticut
Resident Distributor
Name of Distributor _____________________________________________ Distributor’s License No. __________________________
Address of Distributor ___________________________________________________________________________________________
Cigarettes to which Connecticut cigarette stamps or decals were affixed were transferred from Connecticut into:
Du
(Consignee’s state) ______________________________________
ring the month of __________________________ 20 _______
Include all sales, transfers, and returns outside Connecticut during the month. Use separate sheets for each state.
Column 1
Column 2
Column 3
Column 4
Date
Name and Address To Whom Sold, Transferred, or Returned
Invoice No.
No. of Cigarettes
Subtotal for this page
Subtotal from reverse
Total
(Continue on reverse side if necessary)