Form 69-315 - Texas Certificate Of Tax Exempt Sale
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1
269-315
PRINT FORM
CLEAR FORM
(9-09)
b.
TEXAS CERTIFICATE OF TAX EXEMPT SALE – EFFECTIVE 9/1/2009
UNSTAMPED CIGARETTES, UNTAXED CIGARS AND/OR UNTAXED TOBACCO PRODUCTS
• COMPLETE A SEPARATE FORM FOR EACH TRANSACTION
• PLEASE TYPE OR PRINT.
SOLD BY TEXAS PERMITTED DISTRIBUTOR
a. Taxpayer number
c. Filing period
Month ending ______________________
(month, year)
d. Name of distributor
e. Address of distributor
City
State
ZIP Code
PURCHASED BY OR DELIVERED TO
f. Name
g. Address
City
State
ZIP Code
h. Purchaser or authorized agent requesting shipment
i. Date of delivery of shipment (Month, day, year)
j. Invoice number covering shipment
CONTENTS OF SHIPMENT - Number of cigarettes, tobacco product totals and number of cigars
CIGARETTES
TOBACCO PRODUCTS
NUMBER OF CIGARS
2.
1.
3.
4.
5.
6.
CLASS W
CLASS F
Chewing tobacco, snuff, pipe tobacco,
CLASS B
CLASS C
CLASS D
Number
Cigars weighing
Cigars weighing
Cigars weighing
roll-your-own and other tobacco products
Little cigars with a
3 Lbs. / thousand of
3 Lbs. / thousand
3 Lbs. / thousand of
of
weight of
Number
Weight (in ounces)
substantial non-tobacco
cigarettes
selling for
natural leaf selling for
not more than
filler selling for
of all individual
of all individual
3 Lbs. / thousand
3.3 cents or less
over 3.3 cents each
over 3.3 cents each
cans or packages
cans or packages
weighing 1.2 oz. or less
weighing over 1.2 oz.
ea.
oz.
PURCHASER SECTION - Purchaser MUST complete this section.
I hereby certify that no tax is due on the purchase of the merchandise itemized above, since the sale of this merchandise is being made to a federal
instrumentality, and I certify that I am authorized to sign this certificate on behalf of the purchaser named above.
7. Name of authorized agent (Please print)
8. Title
9.
Service number (Member of armed forces) ____________________________________________
Social Security number (Civilian employee) ___________________________________________
DISTRIBUTOR SECTION - Distributor MUST complete this section.
I hereby certify that the sale of the merchandise itemized above is being made to a federal instrumentality.
10. Name of distributor or authorized agent (Please print)
11. Date
Three completed copies of this form are necessary:
one to submit with the monthly report, one for the distributor and one for the purchaser.
You have certain rights under Ch. 552 and 559, Government Code, to review, request and correct information we have on file about you.
To request information for review or to request error correction, contact us at the address or phone numbers listed on this form.
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