Form Cig-1 - Distributor'S Cigarette Stamp Order Blank - Maine Revenue Services
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1Cig
Maine Revenue Services
031800000
Distributor's Cigarette Stamp
Order Blank
Registration Number
Period
-
-
1. Entity Information
Use this area only to report changes in your business
2.
OUT OF BUSINESS?
Check here
, return permit to Bureau and
complete information at right. Date closed
3.
OWNERSHIP CHANGE? If you have changed ownership, indicate the date
when this occurred here
and check off type of change below:
Incorporated
Partner added or dropped
Other (explain on reverse)
Sold to
ADDRESS CHANGE?: If your address above is incorrect, please
4.
NAME CHANGE?
Attach explanation to this return.
make the appropriate changes to the preprinted address.
Do Not Use Red Ink!
Type of
Stamps
Quantity of Stamps
Stamp
per Roll
being ordered
Amount Due
$1.00
5,000
1.
,
,
@ $1.00 each
,
.
Stamp
$1.00
30,000
Order
2.
,
,
@ $1.00 each
,
.
$1.25
5,000
3.
,
,
@ $1.25 each
,
.
Stamp
Value of stamps
Number of Stamps returned
4.
,
,
,
.
returned
Returns
Total Due Total line 1 + line 2 + line 3 - line 4
5.
,
,
.
Discount Discount @ 2.03%
6.
,
,
.
Amount Due Line 5 minus line 6.
7.
,
,
.
Credit Due If Line 5 minus line 6 is a credit amount, enter the amount to the right.
8.
,
,
.
For Office Use Only
Roll #
Roll #
Order #
to
,
,
to
,
,
Dist. by:
Date
to
,
,
Checked by:
Date
to
,
,
to
,
,
Signature
Title
Date
Phone #
Cig-1 Revised 1/03
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