Form Ct-11c - Non-Stamper Cigarette Excise Return
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1
2Rev. 7/13
Massachusetts
Form CT-11C
Department of
Non-Stamper Cigarette Excise Return
Revenue
This return is due on or before the 20th day of the month following the close of each calendar quarter. For the quarter ending
Name
Social Security number
For the quarter ending
September 30, 2013
Address
City/Town
State
Zip
Non-Massachusetts Stamped Cigarette Purchases.
Documentation must be provided upon request.
b. Cigarette excise paid
Date of
Name of seller,
a. Number of
to another jurisdiction
purchase
city and state
Brand name
cartons purchased
(if any; see instructions)
1 Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cigarette Excise
2 Total cartons purchased from line 1, column a for the period July 1, 2013 through July 30, 2013 . . . . . . . . . . . . . . . . . . . . . . 2
25.10
3 Massachusetts cigarette excise rate ($25.10 per carton). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Massachusetts cigarette excise. Multiply line 2 by line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Total cartons purchased from line 1, column a for the period July 31, 2013 through September 30, 2013 . . . . . . . . . . . . . . . 5
35.10
6 Massachusetts cigarette excise rate ($35.10 per carton). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Massachusetts cigarette excise. Multiply line 5 by line 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Total Massachusetts cigarette excise. Add lines 4 and 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Credit for cigarette excise paid to another state. Enter the amount from line 1, col. b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Net Massachusetts cigarette excise due. Subtract line 9 from line 8. Not less than “0” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Penalties
11
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Interest
12
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
13 Total amount due. Add lines 10 through 12
13
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Declaration
I declare under the penalties of perjury that this return has been examined by me and to the best of my knowledge and belief is a true, correct
and complete return.
Signature
Date
Return and payment are due on or before the 20th day of the month following the close of the calendar quarter. Mail to: Massachusetts Department of
Revenue, PO Box 7004, Boston, MA 02204. Make check or money order payable to: Commonwealth of Massachusetts.
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