Schedule D (Form Rev-1033) - Little Cigars Sold Outside Pa

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REV-1033 A AS (01-13)
SCHEDULE D
Resident Cigarette Stamping
Agency Reporting of
LITTLE CIGARS SOLD
BUREAU OF BUSINESS TRUST FUND TAXES
Out-Of-State Little Cigar 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 little cigars were sold during the reporting month.
2. Enter the total number of invoiced little cigars sales.
3. Enter the total number of little cigars sticks sold.
1.State
2. Invoiced Little Cigars Sales
3. Number of Little Cigars (Sticks)
1
If additional space is needed, attach additional 8
/
” x 11” sheets.
2

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