Form Tt-14 - Monthly Report Of Non-Resident Cigarette Stamping Agent - 2004 Page 4
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5TT-14
Mail To:
Schedule D
(Rev 10/04)
Department of Taxation
Stamping Agent’s Monthly Report of Virginia Stamped Cigarettes
P. O. Box 715
By Non-Participating Manufacturer’s Brand Family
Richmond, VA 23218-0715
• List all cigarettes stamped with a Virginia tax stamp for the report month.
Page
of
• This form should be used for Non-Participating Manufacturers (NPM).
Reporting Month / Year:
Your Permit Number:
Your Business Name:
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Under penalty of perjury, I hereby declare that this report is true and correct.
Signature and Title
Date
Name Printed
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