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DAS-27 (08-11)

NONRESIDENT STAMP AFFIXING

AGENCY MONTHLY REPORT OF

BUREAU OF BUSINESS TRUST FUND TAXES

CIGARETTES AND CIGARETTE TAX

PO BOX 280909

STAMPS REV-1036 INSTRUCTIONS

HARRISBURG, PA 17128-0909

REV-1036 and applicable schedules will show accountability of all cigarettes and/or stampable little cigars* and cigarette tax stamps for the

reporting period. Schedules A, C and D must accompany the report when applicable.

Due Date: Reports and appropriate schedules are due on or before the 20th day following the month in which the report is being made.

The cigarette stamping agency’s (CSA) name, CSA number and business address must be entered in the appropriate space provided on the

front of the report and on each schedule and/or supporting statement.

The report must be examined and signed by the owner, partner or officer.

Records must be maintained at the licensed premises for a period of four years and shall be available for examination by the department.

*Stampable little cigars are defined as little cigars packaged similar to a pack of cigarettes, containing 20 to 25 sticks per pack.

INSTRUCTIONS BY LINE NUMBER

STAMPED CIGARETTE ACCOUNT

PENNSYLVANIA STAMPED CIGARETTES ON HAND

TOTAL TO BE ACCOUNTED FOR

BEGINNING OF MONTH

Enter total cigarettes and/or stampable little cigars to be

Enter the amount of Pennsylvania stamped cigarettes and/or

accounted for the reporting month: Line 4 minus Line 5.

stampable little cigars in inventory at the beginning of the

month. This figure must agree with the figure shown on Line

UNSTAMPED CIGARETTES SOLD TO EXEMPT

5 of the previous month’s report.

ORGANIZATIONS

Enter the total of cigarettes and/or stampable little cigars sold

NUMBER OF CIGARETTES PENNSYLVANIA STAMPED

to tax exempt organizations. Schedule C DAS-34, must be

DURING MONTH

completed and accompany this report.

Enter number of cigarettes and/or stampable little cigars

Pennsylvania stamped during the month. This total must come

from Line 21.

STAMPED CIGARETTES SOLD INTO PENNSYLVANIA

Enter total of stamped cigarettes and/or stampable little cigars

PENNSYLVANIA STAMPED CIGARETTES RECEIVED

sold into Pennsylvania during the month. Schedule D –

DURING MONTH

REV-1032 and/or REV-1032-A, must be completed and

Enter number of Pennsylvania stamped cigarettes and/or

accompany this report.

stampable little cigars received during the month. This total

brought from Schedule A reverse side REV-1036.

OTHER CREDITS

Enter total credits, such as cigarettes and/or stampable little

TOTAL

cigars returned to manufacturers, etc. Supporting statement

Enter total of cigarettes and/or stampable little cigars in inven-

tory beginning of month, cigarettes and/or stampable little

must accompany the report.

cigars stamped during month and stamped cigarettes and/or

stampable little cigars received during the month: Lines 1

10. TOTAL SALES AND CREDITS

thru 3.

Enter total cigarettes sold in Pennsylvania and credits. Lines 8

plus 9.

PENNSYLVANIA STAMPED CIGARETTES ON HAND AT

END OF MONTH

11. OVER AND UNDER

Enter total of cigarettes and/or stampable little cigars in inven-

tory at end of the month.

Enter discrepancy, if any. Line 10 minus 6.

PA CIGARETTE TAX STAMP ACCOUNT

12.

OPENING INVENTORY

14.

ADDITIONAL PURCHASES

Enter the amount of unused cigarette tax stamps in invento-

Enter total of cigarette tax stamps received from others.

ry at the beginning of the month.

Subject to prior approval from the department.

13.

PURCHASED FROM DEPARTMENT

15.

TOTAL

Enter total amount of cigarette tax stamps purchased from

Enter total tax stamps available for usage as result of inven-

the department during the month.

tory and purchases. Total of Lines 12, 13 and 14.

Instructions For Form Rev-1036 - Nonresident Stamp Affixing Agency Monthly Report Of Cigarettes And Cigarette Tax Stamps

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