Form 69-133 - Texas Distributor Monthly Report Of Cigar And/or Tobacco Products

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AB CD
69-133
PRINT FORM
CLEAR FIELDS
(Rev.9-13/2)
b.
b
Texas Distributor Monthly Report of
under Chapters 552 and 559, Government Code,
Cigar and/or Tobacco Products
You have certain rights
to review, request and correct information we have on file about you.
18100
a. T code
Contact us at the address or phone number listed on this form.
b
c. Taxpayer number
d. Filing period
e.
f. Due date
MONTH ENDING
b
b
IMPORTANT - Blacken this box if:
g. Taxpayer name and tax report mailing address (Make any name and address changes below.)
h.
your mailing address has changed,
I
your permitted location address has changed, or
1.
I
you are no longer in business at this location.
R b
I
i.
j.
k.
b
b
b
l. Location number
b
A change to
m. Permitted location name and address
the permitted
A report must
location address
be filed even
will require a
if no tax is due.
new permit.
(See instructions.)
See product
CLASS W
CLASS B
CLASS C
CLASS D
CLASS F
class definitions
Enter volume
Enter volume
Enter volume
Enter volume
Enter number
Enter weight
on back of form.
Section I - Permitted Location in Texas
(See instructions.)
.
1. Purchases
b
b
b
b
b
b
.
2. Interstate sales
b
b
b
b
b
b
3. Federal/military
.
sales
b
b
b
b
b
b
4. Native American
.
Reservation sales
b
b
b
b
b
b
.
5. Lost in shipment
b
b
b
b
b
b
.
6. Total deductions
b
b
b
b
b
b
.
7. Taxable amounts
b
b
b
b
b
b
Section II - Permitted Location Outside Texas
(See instructions.)
8. Tobacco products
.
sent to Texas
b
b
b
b
b
b
Section III - Permitted Location in Texas - Reporting Texas Sales Only
(See instructions.)
9. Tobacco products
.
sold in Texas
b
b
b
b
b
b
10. TAX RATE
11. Tax Due
.
.
.
.
.
.
12. Net Tax Due (Total tax due from all columns in Item 11)
12.
.
b
13. Authorized Credits (See instructions.)
13.
.
b
14. Fee Due (Sum of Items 5d and 6d from Form 69-134)
14.
.
b
15. Total Tax and Fee Due (Item 12 minus Item 13 plus Item 14)
15.
.
b
Form 69-133 (Rev.9-13/2)
16. Penalty and interest (See instructions.)
16.
.
17. TOTAL AMOUNT DUE AND PAYABLE (Item 15 plus Item 16)
17.
.
b
Taxpayer name
AB
n.
o.
b
T Code
Taxpayer number
Period
I declare that the information in this document and all attachments is true and correct
b
b
b
to the best of my knowledge and belief.
Authorized agent
18020
Preparer's name (Please print)
State Comptroller.
Make the amount in Item 17 payable to
Our mailing
P.O. Box 149361, Austin, TX 78714-9361.
address is
Daytime phone
Date
(Area code & number)
For information about Tobacco Tax,
1-800-862-2260
512-463-3731
call
or
.
Details are also available online at
.
111 C

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