FORM M-19
Page 4
(REV. 2006)
PART III - SCHEDULE OF CIGARETTE BRANDS SOLD
List the cigarette brand, cigarette brand style, and number of cigarettes sold (both wholesale and retail sales) during the month:
Cigarette Brand
Cigarette Brand Style
Number of Cigarettes Sold
Total Number of Cigarettes Sold
PART IV - SCHEDULE OF CIGARETTES SOLD, USED, AND POSSESSED
CIGARETTES
TOTAL WHOLESALE VALUE
1. Number of cigarettes sold at wholesale during the month .......................................................
$
1
2. Number of cigarettes sold at retail during the month ...............................................................
$
2
3. Number of cigarettes used during the month subject to the tax...............................................
$
3
4. Total number of cigarettes sold and used during the month (add lines 1, 2, and 3).................................................................
4
5. Less non-taxable sales (Number of cigarettes from page 2, Part I, Non-Taxable Sales of Cigarettes) ...................................
5
6. Total taxable cigarettes (line 4 minus line 5) ............................................................................................................................
6
PART V - CIGARETTE TAX STAMPS INVENTORY
Caution: See instructions before completing Part V.
BLUE STAMPS
ORANGE STAMPS
1.
Number of cigarette tax stamps on hand at beginning of the month . . . . . . . . . . . . . . . . .
2.
Number of cigarette tax stamps purchased during the month . . . . . . . . . . . . . . . . . . . . .
3.
Number of cigarette tax stamps transferred in during the month . . . . . . . . . . . . . . . . . . .
4.
Add lines 1, 2, and 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
Number of cigarette tax stamps affixed to cigarette packages during the month . . . . . . . . . . .
6.
Number of cigarette tax stamps transferred out during the month . . . . . . . . . . . . . . . . . .
7.
Number of unused cigarette tax stamps returned for a refund during the month . . . . . . . . . . .
8.
Add lines 5, 6, and 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9.
Number of cigarette tax stamps on hand at end of the month (line 4 minus line 8) . . . . . . . . . .
1
2
3
4
