Form Cig50022 - Order Blank Oklahoma Cigarette Tax Stamp For Sales Of Native American Tax-Free

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Form CIG50022
Revised 10-2011
Order Blank
CIG
Oklahoma Cigarette Tax Stamp
for Sales of Native American Tax-Free
Date of Order
Firm Name
FEI/SSN
Cigarette License Number
Shipping Address
Contact Person
Telephone
Shipping City, State, Zip
Email
Fax
Format
Color
Type
Number of Stamps
Denominations
30,000 per roll
Tax Free
Black
Roll
(20-pack)
X
150 per sheet
Tax Free
Black
Sheet
(25-pack)
Y
Total Stamps
1.
Shipping Carrier and Account Number
Shipping Billing Number
2a.
2b.
Acknowledgment
For OTC Purposes Only
Printed Name
Quantity
Beginning Roll Number
Ending Roll Number
Signature
Date
Bring your completed order blank to our physical address:
Mail completed order blank to:
Oklahoma Tax Commission
Oklahoma Tax Commission
Connors Building - 1st Floor Cashier
Attn: Cigarette Tax Stamp Order
Post Office Box 269060
2501 North Lincoln Boulevard
Oklahoma City, OK 73126-9060
Oklahoma City, OK 73194-0010

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