Schedule Ct-Npm - Stamper'S Reporting Schedule On Sales By Non-Participating Manufacturers

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Rev. 9/12

Schedule CT-NPM

Massachusetts

Stamper’s Reporting Schedule

Department of

on Sales By Non-Participating Manufacturers

Revenue

Return your completed Schedule CT-NPM within 20 days of the close of the reporting month.

Business name

Name of contact person

Telephone of contact person

Taxpayer Identification number

Mailing address

City/Town

State

Zip

Reporting month and year

Provide the following information with respect to individual cigarettes (“sticks”) that originated from a Non-Participating Manufacturer (NPM) and that you stamped for sale. Please print carefully or type.

If you need more space, please provide the required information on copies of this form.

c. Number of

d. Total number of

Brand name

Name and address of NPM that manufactured the brand a a n n d d name and address of

sticks of this brand

Beginning

(do not break down into sub-categories,

person from whom brand was purchased, if not from NPM. A A l l s s o o provide name and

stamped for sale in

stamped for sale

inventory of

Purchases of

Ending inventory

such as regular, menthol, light, etc.)

address of first importer of foreign manufactured brands.

Massachusetts

in other states*

this brand

of this brand

*List number of sticks for each state here or on an attachment.

You must report numbers of sticks, not packs or cartons. Also, you must submit a signed Schedule CT-NPM with Form CT-1 or Form CTS-1NR even if you did not purchase any brands from an NPM or if

the number required in any column is “0.”

Note: Before stamping NPM cigarettes for sale in Massachusetts, you must obtain from each NPM a copy of its executed Massachusetts Certificate of Compliance by Non-Participating Manufacturer and

provide a copy to the Department of Revenue with your monthly stampers returns.

Declaration

The undersigned certifies under the penalties of perjury that all items and statements herein contained and upon schedules attached hereto are true and accurate in every particular.

Signature

Title

Date

Mail completed schedule, along with Form CT-1 or Form CTS-1NR, to: Massachusetts Department of Revenue, Cigarette Excise Unit, PO Box 7004, Boston, MA 02204.