Form Ct-13 - Cigarettes Returned To Manufacturer With Tax Stamps Affixed To Original Packages

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INDIANA DEPARTMENT OF REVENUE
SHEET NO. ___________
CIGARETTES RETURNED TO MANUFACTURER WITH
TAX STAMPS AFFIXED TO ORIGINAL PACKAGES
CT - 13
SF 46858 Rev. 5-97
Distributor’s Name _____________________________________________ Distributor’s License # ___________
Period of _________________ , ______
NO.OF PKGS
PACKAGE
NO. OF
STATE TAX
DATE
DATE
MANUFACTURER
AFFIDAVIT #
RETURNED
SIZE
CIGARETTES
AFFIXED
RETURNED
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
INDIANA
TOTAL INDIANA STAMPED CIGARETTES
RETURNED TO MANUFACTURER
TOTAL ________________ STAMPED CIGARETTES
RETURNED TO MANUFACTURER
TOTAL ________________ STAMPED CIGARETTES
RETURNED TO MANUFACTURER
OUT-OF-STATE DISTRIBUTORS: Total the Indiana stamped cigarettes returned to manufacturer -- Report this total on CT-24,
Line 4.
IN-STATE DISTRIBUTORS: Total the other states stamped cigarettes returned to manufacturer -- Report this total on CT-5, Line 5.
Show states separately.

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