Schedule Cd (Form Rc-10) - Out-Of-State Cigarette Sales Or Shipments - 2001

Illinois Department of Revenue

Schedule CD

Out-of-State Cigarette Sales or Shipments

Read this information first

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• You must complete a separate schedule for each state into which you shipped or sold cigarettes. This includes cigarettes you returned to manufacturers.

• 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 ____________________________________________________________________

Date __ __ __ __/__ __ __ __

Month

Year

Name _______________________________________________________________________________________________

FEIN __ __ - __ __ __ __ __ __

DBA _______________________________________________________________________________________________

SSN __ __ __ - __ __ - __ __ __ __

Street address ________________________________________________________________________________________

Cig. license no. ___________________

City, state, ZIP ________________________________________________________________________________________

Your state’s account no._____________

See the back of this schedule for detailed instructions.

1

2

3

4

5

6

7

8

9

10

How

Invoice Account

Name and address of person to whom

# of packs # of packs

Other

No. of cigarettes Tax paid

Date

shipped number number

cigarettes were shipped or sold

(20’s)

(25’s)

(specify)

(total sticks)

(yes/no)

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Subtotal: This page only

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Grand total

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RC-10 (R-10/01)

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