Form Ct-10 - Cigarette Excise Return

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Massachusetts Department of Revenue
CT–10
Cigarette Excise Return
Rev. 10/99
Trade name
License number
Street address
Classification
City/Town
State
Zip
Month of return
If you are a vending machine operator, state number of machines on location
Number of tax-paid cigarettes
1 Inventory at beginning of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Purchased or acquired during month. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Line 1 plus line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Inventory at end of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Total number of cigarettes sold in Massachusetts during month (subtract line 4 from line 3). . . . . . . . . . . 5
The undersigned licensee certifies under the penalties of perjury that all items and statements herein contained are true and accurate, that there has been full com-
pliance with the requirements of Ch. 62C and 64C, including rules and regulations, and that it has made no purchases and has no inventory of tax free cigarettes.
Name of licensee ______________________________________________ By ______________________ Date _____________________

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