Instructions:
Form CIG50020
Please Note:
Use an original form and complete legibly in order to ensure that your order is properly and promptly processed.
Section A: Buyer Information
Complete all requested information regarding your wholesale company.
Section B: Order Information
Enter total number of tax stamps of each type you wish to order on the appropriate line.
• One roll of tax stamps for 20-pack cigarettes has 30,000 stamps.
• One sheet of tax stamps for 25-pack cigarettes has 150 stamps.
In the Tax Due column, calculate the amount of tax for each type of stamp ordered.
• State/Tribal T - The gross cost for one roll of 30,000 stamps for 20-pack cigarettes is $15,450.00.
• State/Tribal U - The gross cost for one sheet of 150 stamps for 25-pack cigarettes is $96.56.
• Unity Rate K - The gross cost for one roll of 30,000 stamps for 20-pack cigarettes is $19,950.00.
• Unity Rate L - The gross cost for one sheet of 150 stamps for 25-pack cigarettes is $124.76.
• New Unity Rate Q - The gross cost for one roll of 30,000 stamps for 20-pack cigarettes is $30,900.00.
• New Unity Rate R - The gross cost for one sheet of 150 stamps for 25-pack cigarettes is $193.13.
(Please round up on 5 and round down on 4 in the thousandths place.)
1. Total “Tax Due” column.
2a. Calculate total number of tax stamps ordered for all types.
2b. Calculate stamp purchase discount of $0.015 per stamp.
• The discount for a roll or 30,000 20-pack stamps is $450.00.
• The discount for a sheet of 150 25-pack stamps is $2.25.
3.
Subtract the calculated discount amount in line 2b from the total gross value in line 1.
4a. Indicate your shipping carrier and account number, if applicable.
4b. Indicate your carrier billing number, if applicable.
Section C: Bank/Buyer Acknowledgement
Please acknowledge stamps purchased by completely filling out the Bank/Buyer information.
Section D: For Banks/OTC Use Only
Please detail the Roll/Sheet numbers associated with stamps delivered to the buyer.
Definitions:
“State/Tribal Compact” means Compacts entered into between the State and Native American Tribes and Nations,
effective on or after July 1, 2008, providing for payment of a State reduced cigarette excise tax rate and Tribal Tax,
evidenced by a joint State/Tribal tax stamp.
“Unity Rate Compact” means Compacts entered into between the State and Native American Tribes and Nations effective
on or after August 24, 2012, providing for payment of a State reduced cigarette excise tax and Tribal tax, evidenced by a
joint Unity Rate tax stamp.
“New Unity Rate” means compacts entered into between the State and Native American Tribes and Nations effective on
or after August 24, 2012, providing for payment of a State reduced cigarette excise tax and Tribal tax, evidenced by a joint
New Unity Rate tax stamp.
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