Form Rc-16 - Certification Of Cigarette Stamp Roll Shortage
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1Certification of Cigarette Stamp Roll Shortage
_______________________________________________________
_______________________________________________________
Name
Title
________________________________________________________________________________________________________________
Street address
City
State
ZIP
As a representative for the Illinois Department of Revenue, I certify that I personally reviewed the cigarette stamp roll with a representative of
____________________________________ to verify ____________________________’s claim pertaining to a shortage of _____ cigarette
Name of stamp supplier
Name of licensed distributor
Number
revenue stamps on roll number ______.
I
have
have not
attached documents to substantiate this claim.
Number
Under penalties of perjury, I state that I have examined this certification and, to the best of my knowledge, it is true, correct, and complete.
_______________________________________________________
_______________________________________________________
Department of Revenue representative
Company representative
Form RC-16 Information
Under what circumstances can I file a claim for stamps
What if the number of stamps destroyed does not match
attached to cigarettes that will remain in Illinois?
the number contained in my claim?
If the cigarettes to which the cigarette revenue stamps are affixed will
In a certain series of stamps, if a greater number of stamps is
remain in Illinois, you may not file a claim for credit for the stamps
destroyed than is listed on your claim, we will not give credit for the
unless
excess number of stamps destroyed in that series.
we first give approval for the cigarettes to be destroyed in Illinois
In a certain series of stamps, if a lesser number of stamps is
instead of being returned to the manufacturer and the destruc-
destroyed than is included in your claim, we will give credit for only
tion of the cigarettes occurs in the presence of our authorized
the actual number of stamps destroyed in that series.
representative, or
the stamps are affixed to unsalable cigarettes that you will
If stamps in a series not listed in your claim are destroyed, we will
destroy after the stamps are destroyed and the destruction of
not issue credit for the stamps in that series.
the cigarettes occurs in the presence of our authorized
representative.
Do I need to provide proof of the destruction of
cigarettes?
Under what circumstances can I file a claim for stamps
If the claim reveals that you are to destroy cigarettes and we give
affixed to cigarettes that will be shipped by way of
our approval for the cigarettes to be destroyed in Illinois instead of
interstate commerce?
being returned to the manufacturer, and if we assign a representa-
If the cigarettes to which the cigarette revenue stamps are affixed will
tive to witness the destruction of the cigarettes, we will not issue a
be shipped by way of interstate commerce, you may not file a claim
credit for the stamps until you send us proof of the cigarettes’
for credit for the stamps unless the cigarettes are moved by a
destruction in the form of an affidavit executed by our representative
common carrier or through the United States mail.
who witnessed the cigarettes’ destruction.
If the cigarettes are to be shipped by way of interstate commerce to a
Can I receive a credit for stamps if I fail to properly
manufacturer, we will not issue a credit for the stamps until you send
complete Schedules CD and CF?
us
We will not issue a credit for the stamps if a review of your cigarette
a waybill, freight bill, or bill of lading issued by a common carrier,
revenue return (Form RC-6 or Form RC-6-A) reveals that you have
an insurance receipt or registry receipt issued by the United
not properly completed Schedules CD and CF.
States Postal Service, or
Post Office Department Receipt Form 3817,
Can additional proof be required to support my claim?
proving that the cigarettes have actually moved in interstate com-
In addition to the types of proof specified above, we reserve the
merce to the consignee designated in the claim. The carrier must
right to require such additional proof in support of your claim as we
sign this document. In addition, the manufacturer must send us an
deem necessary.
affidavit attesting to the cigarettes’ destruction.
Should I remove the stamps that are to be destroyed from
the cigarette packages to which they are affixed?
If we assign a representative to witness the destruction of the stamps
that are affixed to cigarette packages, you may not remove the
stamps from the cigarette packages unless our representative is
present to witness the stamps’ destruction.
RC-16 back (R-7/96)
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