Form 69-134 - Texas Distributor Monthly Report Of Tobacco Products - Class W Worksheet
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169-134
(Rev.6-12/2)
b.
Texas Distributor Monthly
Report of Tobacco Products - Class W Worksheet
This worksheet must be attached to Form 69-133, the Texas Distributor
Report of Cigar and/or Tobacco Products - Effective 9/ 1/ 2009.
a. Taxpayer number
c. Filing period
d.
e. Due date
You have certain rights under Chapters 552 and 559,
f. Taxpayer name
Government Code, to view, request, and correct information
we have on file about you. Contact us at the address or
phone number listed on this form.
g. Permitted location name and address:
h. Location number
ENTER WEIGHT
ENTER NUMBER
of all individual
of all individual
cans and packages
cans and packages
weighing over 1.2 oz.
weighing 1.2 oz. or less
(Ounces rounded to hundredths)
1a.
1b.
1. Chewing tobacco
2. Snuff
2a.
2b.
3. Pipe tobacco
3a.
3b.
4. Roll-your-own
4a.
4b.
5. Other tobacco products
(Any article or product that is made of tobacco
5a.
5b.
or a tobacco substitute that is not a cigarette.)
6. Purchases for permitted location in Texas
(Add Items 1 through 5)
6a.
6b.
i. Check one:
SECTION I - PERMITTED LOCATION IN TEXAS
(Report the amounts from Items 6a and 6b above on Form 69-133, Item 1, Class W Purchases.)
SECTION II - PERMITTED LOCATION OUTSIDE TEXAS
(Report the amounts from Items 6a and 6b above on Form 69-133, Item 8, Class W Tobacco products sent to Texas.)
SECTION III - PERMITTED LOCATION IN TEXAS REPORTING TEXAS SALES ONLY
(Report the amounts from Items 6a and 6b above on Form 69-133, Item 9, Class W Tobacco products sold in Texas.)
If you have any questions regarding Cigarette/Tobacco Tax, contact the Texas State Comptroller
at 1-800-862-2260 or 512-463-3731. Our Web address is
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