Form 70-050 - Schedule C - Reporting Of Out-Of-State Sales Of Cigarettes

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Iowa In-State Distributors - Schedule C
Iowa Department of Revenue
Reporting of Out-of-State Sales of Cigarettes
Complete a separate schedule for each state cigarettes were sold.
FILE IN DUPLICATE
Name:
Cigarettes transferred into state of:
DBA:
Month:
Year:
Street Address:
FEIN No.:
City:
Social Security No.:
State:
Zip:
Cigarette License No.:
Column Instructions
4. Complete Name, Address and City of company of
1. Date of shipment or transfer out of state.
person to whom cigarettes were sold.
2. Indicate how shipped: DT, Distr Truck; CC, Common Carrier;
5. Number of packages of 20’s.
PP, Parcel Post; CT, Customer Truck.
6. Number of packages of 25’s.
3. Invoice number of product shipped into another state.
7. Indicate whether shipped cigarettes were tax paid.
Indicate shipments of “Little Cigars.”
Shipment of Untaxed Cigarettes by Distributors
List separately from shipments of cigarettes.
Not Permitted in Iowa.
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Date
Ship
Invoice
To Whom Sold – Name and Address
# Packs
# Packs Tax Paid
Number
(20’s)
(25’s)
(Yes/No)
This report is to be made in duplicate.
Sub Total:
This Page Only ____________
Mail original and duplicate to:
Grand Total ____________
Iowa Department of Revenue
Cigarette Tax Unit
PO Box 10456
Des Moines IA 50306-0456
Attach to Form 70-017 Iowa Cigarette Tax Report for In-State Distributors
70-050 (06/11/10)

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