Form Cig - Wyoming Cigarette Stamp Order Form - 2007
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1T
S
W
HE
TATE
OF
YOMING
D
R
EPARTMENT OF
EVENUE
Herschler Building ο 2nd Floor West
D
F
, G
AVE
REUDENTHAL
OVERNOR
ο
82002-0110
122 W. 25TH STREET
CHEYENNE, WYOMING
E
J. S
, D
DMUND
CHMIDT
IRECTOR
(307) 777-5200 ο
: dor@state.wy.us
TELEPHONE
E-MAIL
WEB SITE
W
C
yoming
igarette Stamp Order For
From: ___________________________________ License Number: ___________________
Name the License was Issued Under
Contact Person: __________________________ Phone Number: (
)_____-__________
Fax Number: (
)_____-__________
Ship Stamps to:_____________________________________________________________
City: ________________________State: ______________________Zip: ________________
Heat Fusion (30,000 to a roll)
Quantity of Stamps….. . __________________
Value at $.60……………$_________________
Less your 6% discount $_________________
Less Credit Memo
$_________________
Amount of Remittance $__________________
Shipping Instructions for stamps shipped to your business:
Carrier and type of service (i.e. next day air, priority): _______________________________
Account number: ____________________________
□
□
Do you want shipment insured:
Yes
No
If yes, how much do you want shipment insured for: $______________________
∗
If you are not bonded, CERTIFIED FUNDS or WIRE TRANSFERS are required
.
Submit all orders and remittances to the:
Wyoming Department of Revenue
Cigarette Tax Section
th
122 West 25
Street
Cheyenne, Wyoming 82002-0110
________________________________________________
Authorized Signature
Date
Important Tax Information
Cigarette stamps shall be sold by and purchased from The Wyoming Department of Revenue. The
Department shall only sell stamps to a licensed Wholesale dealer. Stamps shall be sold to the wholesaler at
a discount of 6% in rolls of 30,000.
Any package of cigarettes found in this state without Wyoming stamps, imprints or impressions affixed is
considered contraband goods and may be seized without a warrant by the Department.
Please note: Stamp orders shall not be filled for wholesalers who are out of compliance with any of our rules.
th
Including but not limited to failure to file the monthly report by the 20
day of each month following the
month of the cigarette sales report period.
Cig- Revised 11/01/07
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