Form Dr 1285 - Licensed Distributor Reporting Form For Cigarette Sales Of Non-Participating Manufacturer Brands
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1LICENSED DISTRIBUTOR REPORTING FORM FOR CIGARETTE
DR 1285
Colorado Department of Revenue
SALES OF NON-PARTICIPATING MANUFACTURER BRANDS
Business Tax Accounting Section
1375 Sherman Street
Denver, CO 80261
Please provide the following information with respect to:
(303) 205-8211, Ext. 6860
•
FAX: (303) 866-3211
Cigarettes manufactured by a Non-participating Manufacturer that bear the Colorado cigarette tax stamp
•
Roll-your-own tobacco manufactured by a Non-participating Manufacturer sold in Colorado
TH
DUE DATE: 20
DAY OF EACH MONTH FOLLOWING
SEE REVERSE FOR INSTRUCTIONS
THE CLOSE OF THE REPORTING MONTH
Reporting Month/Year
Business Name
Business Address
Business Registration Number
Contact Person
Telephone Number
________________________________________________________________________________________________________________________________________________
A
B
C
D
E
F
BRAND NAME
NUMBER OF
OUNCES OF
NON-PARTICIPATING MANUFACTURER
NAME AND ADDRESS OF THE
NAME AND ADDRESS OF THE
CIGARETTES
ROLL-YOUR-
NAME AND ADDRESS
PERSON(S) FROM WHOM EACH BRAND
FIRST IMPORTER OF FOREIGN
(STICKS)
OWN TOBACCO
WAS PURCHASED
MANUFACTURED BRANDS
SOLD WITHIN
SOLD WITHIN
COLORADO
COLORADO
I
-
.
CERTIFY THAT THE ABOVE
STATED INFORMATION IS TRUE AND CORRECT
S
__________________________________________
________________________
IGNATURE
DATE
P
N
& T
__________________________________
P
_____
_______
RINT
AME
ITLE
AGE
OF
F
/
(
)
.
AILURE TO FILE THIS REPORT AS REQUIRED MAY RESULT IN THE REVOCIATION OF YOUR CIGARETTE AND
OR TOBACCO PRODUCTS LICENSE
S
FOR A PERIOD OF TWO YEARS
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