Form Cg-403 - Request For Cigarette Stamp Destruction
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1IDAHO STATE TAX COMMISSION
TAX DISCOVERY BUREAU
CG-403
P.O. Box 36
Boise, Idaho 83722-0036
•
EFO00124
06-06-08
REQUEST FOR CIGARETTE STAMP DESTRUCTION
Name of Business
Employer I.D. No.
Permit Number
Address
Phone Number
City, State, Zip
The unusable stamps are located in the warehouse of ________________________________________________________
Wholesaler
at ________________________________________, ___________________________________________________________.
City, County
Street Address
The unusable stamps will be destroyed on __________________________ at ____________ AM/PM.
Date
Time
_____________ total stamps will be destroyed. We will take credit in this amount on our next monthly tax return
REASON FOR DESTRUCTION
Reason
Number of Stamps (20s)
Number of Stamps (25s)
Erroneously applied
stamps returned
Unusable/Damaged
to the Tax Commission
specify
Other
below
TOTALS
METHOD OF DESTRUCTION OF STAMPS
Under penalties of perjury, I certify that the above amount is true and correct and that the products have become unusable and will be
destroyed on the date and time shown above. I understand that I must have an approved copy of this certificate in my possession
before destroying the product(s) identified on this application. I further understand that a representative from the Idaho State Tax
Commission may be present to witness the destruction.
Authorized Signature
Title
Date
Complete the upper portion of this application. Keep one copy. Mail the original and one copy to the Tax Commission 10 days before
the proposed destruction date. Don't destroy the products until you receive the approved original from the Tax Commission.
Attach a copy of the approved original form to the tax report for the month in which the tobacco products were destroyed.
FOR STATE USE ONLY
Approved by
Title
Date
Approved but not witnessed, allowed by Rule 35.01.10.024
Title
Date
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