Form Ct203 - Cigarette Use Tax Return Page 2
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4CT203-A
Cigarettes and Little Cigars Purchased During the Month
Read the instructions prior to completing this schedule.
Page ______ of _____
Name
Social Security Number
Address
City
State
ZIP Code
Period of Return (mo/yr)
Cigarettes
Purchased From
Number of
Cigs.
Total
Date
Invoice #
(name/address of person or firm)
Brand
Cartons
p/Carton
Cigarettes
× 200 =
× 250 =
× 200 =
× 250 =
× 200 =
× 250 =
× 200 =
× 250 =
Line 1 Total number of cigarettes
Little Cigars (less than 3lbs per thousand)
Purchased From
Number of
Cigars
Total
(name/address of person or firm)
Date
Invoice #
Brand
Cartons
p/Carton
Cigars
×
=
×
=
×
=
×
=
×
=
×
=
×
=
×
=
Line 2 Total number of little cigars
Little Cigars (3lbs to 4.5lbs. per thousand)
Purchased From
Number of
Cigars
Total
(name/address of person or firm)
Date
Invoice #
Brand
Cartons
p/Carton
Cigars
×
=
×
=
×
=
×
=
×
=
×
=
×
=
×
=
Line 3 Total number of little cigars
(Rev. 1/18)
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