Form Ct-24 - Out-Of-State Licensed Cigarette Distributor'S Monthly Cigarette Tax Return

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CT-24
Indiana Department of Revenue
SF 48478
P.O. Box 901
Revised 3/09
Indianapolis, IN 46206-0901
OUT-OF-STATE LICENSED CIGARETTE DISTRIBUTOR’S
MONTHLY CIGARETTE TAX RETURN
For the period of ______________________, ______
Name of License Holder (as indicated on license)
Mailing Address
Cigarette Distributor’s License#
City or Town
County
State
Zip Code
Federal ID Number
STAMPED CIGARETTE STOCk ACCOUNT
1. Ending Inventory of Stamped Cigarettes (From attached Schedule CT-11) ......................... 1
2. Wholesale and/or Retail Sales (From attached Schedule CT-12G) ...................................... 2
3. Sales to Indiana Distributors (From attached Schedule CT-12F) ......................................... 3
4. Indiana Stamped Cigarettes Returned to Manufacturer (From attached Schedule CT-13) ..
4
5. Total (Add Lines 1-4) ...........................................................................................................
5
6. Purchases of Stamped Cigarettes (From attached Schedule CT-12C) .................................. 6
7. Indiana Stamped Cigarettes Returned to Warehouse (From attached Schedule CT-12H) .... 7
8. Beginning Inventory of Stamped Cigarettes ......................................................................... 8
9. Total (Add Lines 6-8) ...........................................................................................................
9
10. Number of Cigarettes Stamped During Period (Line 5 minus Line 9) ................................. 10
11. Tax on Stamped Cigarettes (Multiply Line 10 by curent tax rate) ....................................... 11
CIGARETTE TAX STAMP ACCOUNT
A
B
C
Full Roll
Partial Roll and Wides
25’s
Stamps $ Value
Stamps $ Value
Special Stamps $ Value
1. Beginning Inventory of Tax Stamps
2. Purchases of Tax Stamps (From
attached Schedule CT-11)
3. Total Inventory (Add Lines 1 and 2)
4. Ending Inventory of Tax Stamps
(From attached Schedule CT-11)
5. Total Stamps Used (Line 3 minus Line 4)
6. Total Cigarette Tax Stamps Used (Add Line
5 of columns A, B and D)
I hereby declare under penalties of perjury that the information contained in this return, including accompanying schedules and state-
ments, is true, correct and complete to the best of my knowledge and belief.
Signature of Taxpayer or Agent
Title
Telephone Number
Date
(
)
IMPORTANT: A RETURN MUST BE FILED EACH MONTH WITHIN 15 DAYS FOLLOWING THE LAST DAY OF THE
PERIOD BEING REPORTED.
Questions related to this form, please call (317) 615-2710

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