Form Ct-10 - Cigarette Excise Return - Massachusetts Department Of Revenue printable pdf download

Form Ct-10 - Cigarette Excise Return - Massachusetts Department Of Revenue

Massachusetts Department of Revenue

CT–10

Cigarette Excise Return

Rev. 10/99

Trade name

License number

Street address

Classification

City/Town

State

Zip

Month of return

If you are a vending machine operator, state number of machines on location

Number of tax-paid cigarettes

1 Inventory at beginning of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Purchased or acquired during month. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

3 Line 1 plus line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

4 Inventory at end of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

5 Total number of cigarettes sold in Massachusetts during month (subtract line 4 from line 3). . . . . . . . . . . 5

The undersigned licensee certifies under the penalties of perjury that all items and statements herein contained are true and accurate, that there has been full com-

pliance with the requirements of Ch. 62C and 64C, including rules and regulations, and that it has made no purchases and has no inventory of tax free cigarettes.

Name of licensee ______________________________________________ By ______________________ Date _____________________