Form Rev-1043 - Cigarette Stamping Agent Purchase Order Cigarette Tax Indicia

Download a blank fillable Form Rev-1043 - Cigarette Stamping Agent Purchase Order Cigarette Tax Indicia in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Rev-1043 - Cigarette Stamping Agent Purchase Order Cigarette Tax Indicia with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

REV-1043 AS (12-11)
CIGARETTE STAMPING
Federal Employer ID #
AGENT PURCHASE ORDER
BUREAU OF BUSINESS TRUST FUND TAXES
CIGARETTE TAX INDICIA
PO BOX 280909
CSA #
HARRISBURG PA 17128-0909
Date
PRINT OR TYPE ALL INFORMATION AND RETAIN A COPY FOR YOUR RECORDS.
TO:
Department of Revenue
Please provide the information requested above-right and below and indicate denominations and quantities as requested in
the table below to be completed by the CSA.
START
Agency Name
Telephone
Street Address
Fax
City
State
ZIP Code
Web address
STAMPS:
CS1B
CS2A
CS2B
CS4A 25's
CS5A 25's
CS6A Water
Fuson Rolls
Fuson Sheets
Fuson Sheets
(1x10 Carton)
(2x4 Carton)
(10 Pack)
UPS or Fed Ex
PAYMENT: Cash
Charge
SHIPPING METHOD: UPS
Fed Ex
Account Number
TO BE COMPLETED BY CSA
FOR DEPARTMENT USE ONLY
QUANTITY
VALUE
STAMP SERIAL NUMBER(S)
TOTAL VALUE
OF STAMPS
OF STAMPS
$
$
$
SUBTOTAL OF THIS ORDER
LESS CREDIT(S)
NET SALES VALUE
LESS COMMISSION 0.87% (0.0087)
NET REMITTANCE
$
No commission allowed on purchases of less than $100 (gross value). Checks
made payable to PA Department of Revenue are accepted, subject to final pay-
DEPARTMENT USE ONLY
ment and at risk of payer. Deduct credit memos from gross value before calcu-
CSA ACCOUNT
lating your commission.
BALANCE
DUE
Stamp Distribution Center
AMOUNT OF
THIS ORDER
Accepted By
TOTAL
Signature
BOND
PAYMENT
Date
TOTAL
AMOUNT
OF
TELEPHONE: 717-783-9374
BOND
FAX: 717-705-8413
TT#: 1-800-447-3020
VERIFIED
(Service for Taxpayers with Special Hearing
BY
and/or Speaking Needs)
Reset Entire Form
PRINT FORM
Back to top of page.

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Cigarette Stamping Agent Purchase Order Cigarette Tax Indicia Cigarette Stamping Agent Purchase Order Cigarette Tax Indicia Financial
Form Rev-1042 - Cigarette Tax Exemption Certificate Form Rev-1042 - Cigarette Tax Exemption Certificate Financial
Form Rev-142 - Cigarette Stamping Agent Floor Tax Return - 2009 Form Rev-142 - Cigarette Stamping Agent Floor Tax Return - 2009 Financial
Form Rev-1036 - Nonresident Stamp Affixing Agency Monthly Report Of Cigarettes And Cigarette Tax Stamps Form Rev-1036 - Nonresident Stamp Affixing Agency Monthly Report Of Cigarettes And Cigarette Tax Stamps Financial
Form Rev-1030 - Resident Stamp Affixing Agency Monthly Report Of Cigarettes And Cigarette Tax Stamps Form Rev-1030 - Resident Stamp Affixing Agency Monthly Report Of Cigarettes And Cigarette Tax Stamps Financial
Form Cg-25 - Order Form For Cigarette Tax Indicia Form Cg-25 - Order Form For Cigarette Tax Indicia Financial
Form 510 - Oregon Cigarette Tax Stamp Order Form - Tax Year 2013 Form 510 - Oregon Cigarette Tax Stamp Order Form - Tax Year 2013 Business
Form Ct 4a - Cigarette Tax Stamp Order - Indiana Department Of Revenue Form Ct 4a - Cigarette Tax Stamp Order - Indiana Department Of Revenue Financial
Form 04-620 - Cigarette Tax Stamp Order Form - Department Of Revenue Form 04-620 - Cigarette Tax Stamp Order Form - Department Of Revenue Financial
Form 04-620 - Cigarette Tax Stamp Order - 2004 Form 04-620 - Cigarette Tax Stamp Order - 2004 Financial

Related Categories

Parent category: Financial
Download
Go