Form Ct-25 - Nonparticipating Manufacturers Cigarette Report - Indiana Department Of Revenue

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Indiana Department of Revenue
P.O. Box 901
Indianapolis, IN 46206-0901
Nonparticipating
CT-25
Manufacturers Cigarette Report
Page Number ______
Rev. 7/00
Indiana Code 24-3-3-11
Distributor Name
Distributor License Number
Report for the Period of
Instructions: Report only when you stamp Indiana (pay excise tax on) cigarettes made by manufacturers not listed below. A current list of Participating Manufacturers is on the
National Association of Attorney General’s Website: Complete the Distributor Name, Number and Period above. List the Nonparticipating Manufacturer’s Name,
address and the number of cigarettes. Number of cigarettes should be cigarettes, not packs and not cartons.
Important: This schedule must be filed with each Monthly Cigarette Tax Return. If only Participating Manufacturer’s Cigarettes are stamped, complete the Distributor name,
number and period above and write “none” in the Nonparticipating Manufacturer’s Name section.
Note: If the Indiana Cigarette Distributor acquires cigarettes from Participating Manufacturers only, the Department will accept annually an affidavit from the distributor so stating.
The affidavit is due July 1 of each year.
Participating Manufacturers: (As of May 2000)
Brown & Williamson
Alliance Tobacco Corp.
King Maker Marketing
The Medallion Company
Sherman 1400 Broadway
Liggett
Commonwealth Brands
Landmark
Peter Stokkebye International
Societe Nationale d’Exploitation Industrielle
Lorillard
Dhanraj Inernational
Lane Limited
Planta Tabak-Manufaktur Gmbnt. Co.
des Tabacs et Allumettes (Seita)
Phillip Morris
House of Prince
Lignum-2
Premier Marketing
Tobacco Exporters International
RJ Reynolds
Imperial Tobacco Limited, ITL
LTD Corporation
P.T. Djarum
Top Tobacco
Japan Tobacco International
Mac Baren Tobacco Co.
Santa Fe Natural Tobacco
Nonparticipating Manufacturer’s Name
Address
Number of Cigarettes
Attach additional sheets if necessary.
Forms may be obtained from
I hereby declare under penalties of perjury that the information contained in this return, including accompanying schedules and statements is true, correct, and complete to the best
of my knowledge and belief.
Signature of Taxpayer or Agent
Title
Telephone Number
Date

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