Schedule D (Form Rev-1033) - Cigarettes Sold Outside Pa

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REV-1033 AS (01-13)
SCHEDULE D
Resident Cigarette Stamping
Agency Reporting of
CIGARETTES SOLD
BUREAU OF BUSINESS TRUST FUND TAXES
Out-Of-State Cigarette Sales
OUTSIDE PA
PO BOX 280909
HARRISBURG PA 17128-0909
Licensee Name:
Reporting Month:
Year:
Street Address:
FEIN:
City:
State:
ZIP:
PA Cigarette License Number:
1. Enter the state into which cigarettes were sold during the reporting month.
2. Enter the total number of invoiced cigarettes sales.
3. Enter the total number of cigarette sticks sold.
1.State
2. Invoiced Cigarette Sales
3. Number of Cigarettes (Sticks)
1
If additional space is needed, attach additional 8
/
” x 11” sheets.
2

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