Form CFT
Commonwealth of Virginia
Cigarette Floor Tax
• All stamping agents must file this form.
• Only cigarette packs in inventory on hand as of 12:01 am on July 1, 2005, stamped with the old rate
Virginia Revenue
Stamp are subject to the floor tax.
•
Do not report unaffixed
old rate
stamps on this return. Unaffixed stamps are to be returned to the Department for credit
no later than June 30, 2005.
• This form must be filed and the floor tax paid to the Department of Taxation no later than July 11, 2005.
• Checks should be made payable to the Virginia Department of Taxation.
• Mail this form, with your payment, to: Department of Taxation
ATTN: Floor Tax
P. O. Box 1301
Richmond, VA 23218-1301
• If you have questions regarding this form or the Floor Tax, please contact the Fiscal Office at (804) 367-6345.
Name
Permit Number
Mail To:
Trading As
Department of Taxation
ATTN: Floor Tax
Number And Street
P. O. Box 1301
Richmond, VA 23218-1301
City or Town, State, ZIP Code
Use This Form To Calculate and Remit your 2005 Cigarette Floor Tax
A
B
Packages of 20's
Packages of 25's
1. Number of packs on hand 7/1/05 with 20¢/25¢ revenue stamp affixed
2. Cigarette Floor Tax Due (Line 2A = Line 1A X .1 Line 2B = Line 1B X .125)
$
$
3. Total Cigarette Floor Tax Due (Line 2, Column A plus Column B)
$
I hereby declare that this report is true and correct.
By
Signature and Title
Date
Telephone
Print Name
Email Address
If the stamping agent is a corporation, an officer of the corporation authorized to sign on behalf of the corporation must sign; if a partnership, one partner
must sign; if a sole proprietorship, the proprietor must sign.
Va. Dept. of Taxation Form CFT (REV 05/05)