Schedule Ct-1c - Cigarettes Transferred From Massachusetts Into Another State

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Rev. 6/12
Schedule CT-1C
Massachusetts
Cigarettes Transferred from
Department of
Massachusetts into Another State
Revenue
File this form in duplicate. Use separate sheets for each state. Include all sales outside Massachusetts.
License number
For month of
Year
Name of licensee
Mailing address
City/Town
State
Zip
State cigarettes transferred to
To whom sold
Number of cigarettes
Date
Invoice
a. 20s
b. 25s
c. Miscellaneous
transferred
number
Name
Address
Stamped
Stamped
Unstamped
Enter amounts at top of next page
500 9/97 GC96R02
printed on recycled paper

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