Form Cig50020 - Order Blank Oklahoma Cigarette Tax Stamp For Sales Of State/tribal, Unity Rate Stamps And New Unity Rate Stamps

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Form CIG50020
Revised 6-2013
Order Blank
CIG
Oklahoma Cigarette Tax Stamp
for Sales of State/Tribal, Unity Rate Stamps and New Unity Rate Stamps
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
Tax Rate
Denominations
Tax Due
30,000 per roll
State/
$
Orange
$0.515
Roll
(20-pack)
Tribal T
150 per sheet
State/
$
Orange
$0.64375
Sheet
(25-pack)
Tribal U
30,000 per roll
Unity Rate
$
Magenta
$0.6650
Roll
(20-pack)
K
150 per sheet
Unity Rate
$
Magenta
$0.83175
Sheet
(25-pack)
L
New Unity
30,000 per roll
$
$
Tan
$1.03
Roll
Rate
(20-pack)
Q
New Unity
150 per sheet
$
Tan
$1.2875
Sheet
Rate
(25-pack)
R
$
1.
Total Gross Value
Discount Calculation
$(
)
2a.
Total Stamps
2b.
Less: $0.015 per stamp
$
3.
Total Remittance
Shipping Carrier and Account Number
Shipping Billing Number
4a.
4b.
Acknowledgment
For OTC/Bank Purposes Only
Name/Address
Beginning Roll Number
Ending Roll Number
Type Quantity
Agent
Signature
Date
Printed Name
Signature
Date
Bring your completed order blank to our physical address:
Mail completed order blank with your remittance to:
Oklahoma Tax Commission
Oklahoma City:
Tulsa:
Connors Building - 1st Floor Cashier
Kerr State Office Building - 5th Floor
Attn: Cigarette Tax Stamp Order
Post Office Box 269060
2501 North Lincoln Boulevard
440 South Houston, Suite 501B
Oklahoma City, OK 73126-9060
Oklahoma City, OK 73105
Tulsa, OK 74127

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