Form Ctl-2 - Branch Or Stamper Location List

Rev. 3/04

Form CTL-2

Massachusetts

Branch or Stamper

Department of

Location List

Revenue

Business name

Name of contact person

Telephone of contact person

Taxpayer Identification number

Mailing address

City/Town

State

Zip

Number of locations (from Form CTL)

This list must be filed with Form CTL, Application for All Cigarette Licenses. Complete information must be provided below for each branch or stamper location. Send this list with Form CTL to: Massachu-

setts Department of Revenue, Cigarette Excise Unit, PO Box 7004, Boston MA 02204.

Location of branch or stamper

Name

Street address

City/Town

Telephone number

Branch or stamper

100 5/04 CRP0104

printed on recycled paper