Schedule Cd Form - Out-Of-State Cigarette Sales Or Shipments - Il

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Illinois Department of Revenue

Schedule CD

Out-of-State Cigarette Sales or Shipments

Read this information first

• You must complete a separate schedule for each state into which you shipped or sold cigarettes.

• Do not include any cigarettes with Illinois tax stamps affixed that you

and/or

• returned to manufacturers;

• sold to Illinois licensed out-of-state distributors.

• Attach two copies of this schedule to either Form RC-6, Cigarette Revenue Return, or Form RC-6-A, Out-of-State Cigarette Revenue Return.

State into which you shipped cigarettes:_________________________________________________________

Tax period: __ __ / __ __ __ __

Month

Year

Name: ___________________________________________________________________________________

FEIN: __ __ - __ __ __ __ __ __

DBA: ____________________________________________________________________________________

SSN: __ __ __ - __ __ - __ __ __ __

Street address: ____________________________________________________________________________

Illinois Cigarette License no.: ____________________

City, state, ZIP: ____________________________________________________________________________

Illinois Business Tax no.: __ __ __ __ - __ __ __ __

See the back of this schedule for detailed instructions.

Shipping How

Invoice

FEIN

Name and address of person to whom

# of packs # of packs

Other

No. of cigarettes Tax paid

date

shipped number

cigarettes were shipped or sold

(20’s)

(25’s)

(specify)

(total sticks)

(yes/no)

__/__/__ _______ _______ _______ __________________________________________________ _________ _________ _________ ______________ _______

Subtotal: This page only

_________________________

Grand total

_________________________

This form is authorized by the Illinois Cigarette Tax and Cigarette Use Tax acts. Disclosure of this information is REQUIRED. Failure to comply may result in a penalty. This form has been approved by the Forms Management Center. IL-492-1506

RC-10 (R-07/02)

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