Form Rc-10 - Schedule Cd - Out-Of-State Cigarette And Little Cigar Sales Or Shipments

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Illinois Department of Revenue
REV 01 FORM 441
RC-10
Schedule CD
Out-of-State Cigarette and Little Cigar Sales or Shipments
Sheet no. __________
State into which you shipped cigarettes or little cigars: __________________________________
Tax period: __ __ / __ __ __ __
Month
Year
Name: ________________________________________________________________________
FEIN: __ __ - __ __ __ __ __ __ __
DBA: _________________________________________________________________________
SSN: __ __ __ - __ __ - __ __ __ __
Street address: _________________________________________________________________
Illinois Cigarette Distributor License no.: __ __-__ __ __ __ __
City, State, ZIP: _________________________________________________________________
Account ID: __ __ __ __ __ __ __ __
1
2
3
4
5
6
7
8
9
10
Shipping
How
Invoice
FEIN
Name and address of person to whom
# of packs # of packs
Other
Total number Tax paid
date
shipped
number
cigarettes or little cigars were shipped or sold
(20’s)
(25’s) (No. of sticks) of sticks
(yes/no)
__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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__/__/__ _________ _________ _________ __________________________________________________ _______
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_______ ___________ ______
Subtotal: This page only
_________________________
Grand total
_________________________
*344111110*
RC-10 (R-07/13) Schedule CD
This form is authorized as outlined under the tax or fee Act imposing the tax or fee for which this form is filed. Disclosure of this
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.

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