Form 23503 - Schedule Cd - Out-Of-State Cigarette Sales

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SCHEDULE CD - OUT-OF-STATE CIGARETTE SALES
OFFICE OF STATE TAX COMMISSIONER
23503 (6-1998)
Complete a separate schedule for each state into which you shipped or sold cigarettes. File two copies of this schedule.
State into which you shipped cigarettes
Date
(Month and Year)
Name
FEIN
DBA
Social Security Number
Street Address
Cig. License No.
City, State, Zip Code
Your state’s account no.
See the back of this schedule for detailed instructions on completing Columns 1 through 9.
1
2
3
4
5
6
7
8
9
How
Invoice
Name and address of person
# of packs
# of packs
Other
No. of cigarettes
Tax paid
Date
shipped
number
to whom cigarettes were shipped or sold
(20’s)
(25’s)
(specify)
(total sticks)
(yes/no)
Subtotal: This page only ____________________
Grand total ____________________

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