Form Ctx-R - Cigarette Tax Activity Report Page 10

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Schedule
Sale of Cigarettes With
F
Joint NYS/NYC Stamps Affixed
TM
Department of Finance
Report of Sales -
Include sale of cigarettes to dealers for resale outside NYC and returns of cigarettes to all manufacturers and others within NYC.
1. Sold to:
New York State
New York City
Sales
Packing Packing Packing
Miscellaneous
Total
Zip
Street
Name
City
State
Cigarette License Cigarette License
Tax
Size
Size
Size
Cigarettes
Address
Code
Number
Number
ID
10
20
25
Size
No.
Sold (pieces)
2. Total number of cigarettes sold (Enter on Form CTX-R, Schedule IV, Line 4):

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