Form Ctx-R - Cigarette Tax Activity Report Page 3
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10NYC DEPARTMENT OF FINANCE
FORM
FOR DEPARTMENT USE ONLY
SHERIFF DIVISION
CIGARETTE TAX
L.
CTX-R
C
hECKED bY
TM
ACTIVITY REPORT
D
ATE
Department of Finance
R
EMARKS
Mail to: NYC Department of Finance, Sheriff Division, CTX Unit, 30-10 Starr Ave., 2nd Fl., Long Island City, NY 11101
Instructions: Use this form if you are a Licensed Cigarette Agent-Jobber, Sub-Jobber or Vending Machine Operator Activity Report and are
licensed by New York City to stamp or distribute cigarettes within the City of New York. This report must be received with the required support-
ing Cigarette Tax Schedule(s) attached, within 15 days after the end of the required reporting period indicated in Section I, Item 2.
SECTION I - LICENSEES (AGENT-JOBBERS, SUB-JOBBERS AND VENDING MACHINE OPERATORS)
1. Name:
2. Reporting Period:
______________ 20______ TO ______________ 20______
-
-
MONTh
DAY
YEAR
MONTh
DAY
YEAR
3. Street Address:
City:
State:
zip Code:
4. E-mail Address:
5. EIN/SSN:
6. NY State License Number:
7. NY City License Number:
SECTION II - REPORT OF ACTIVITY - UNSTAMPED AND NY STATE STAMPED CIGARETTES
(To be completed by Agent-Jobbers located within New York City.) Indicate the
NUMbER OF INDIVIDUAL CIGARETTES
amounts for lines 1-10 in the appropriate column(s). Enter the number and odd-size
.
Packing Size
Packing Size
Packing Size
MISC
packages in the miscellaneous column. (Example: 5, 24, 100, 240, etc.)
10
20
25
SIzE
NO
1. Inventory of unstamped cigarettes at the beginning of the period........................_____________________________________________________
2. Number of unstamped and New York State stamped cigarettes manufactured,
purchased or otherwise acquired. (Schedule A, Line 2)....................................... _____________________________________________________
3. Total (add Lines 1 and 2)........................................................................................_____________________________________________________
4. Sales made to exempt agencies (Schedule b, Line 2).......................................... _____________________________________________________
5. Sales delivered and transfer(s) made to points outside the State of New York
(Schedule C, Line 2)..............................................................................................._____________________________________________________
6. Sales delivered and transfer(s) made to points outside the City but within the
State of New York. (Schedule D, Line 2)................................................................_____________________________________________________
7. Sales delivered and transfer(s) made to other dealers within the City.
(Schedule E, Line 2)..............................................................................................._____________________________________________________
8. Number of cigarettes returned/destroyed (and not included on either
Schedule C or D)...................................................................................................._____________________________________________________
9. Inventory of unstamped cigarettes at the end of the period..................................._____________________________________________________
10. Total (Add Lines 4 through Line 9)......................................................................... _____________________________________________________
11. balance to be accounted for (Line 3 minus Line 10)............................................. _____________________________________________________
SECTION II-NR - REPORT OF JOINT NYS/NYC STAMPED AND UNSTAMPED CIGARETTES
(To be completed by Non Resident Agent-Jobbers located outside New York City.)
NUMbER OF INDIVIDUAL CIGARETTES
Indicate the amounts for lines 1-10 in the appropriate column(s). Enter the number and
.
Packing Size
Packing Size
Packing Size
MISC
odd-size packages in the miscellaneous column. (Example: 5, 24, 100, 240, etc.)
10
20
25
SIzE
NO
A.
REPORT OF NEW YORK CITY STAMPED CIGARETTES
1. Inventory of stamped cigarettes at beginning of the period................................... _____________________________________________________
2. Number of cigarettes stamped during the period ..................................................._____________________________________________________
3. Number of cigarettes received from agents (with stamp affixed)..........................._____________________________________________________
4. Total (Add Lines 1 through 3)................................................................................. _____________________________________________________
5. Inventory of stamped cigarettes at end of period..................................................._____________________________________________________
6. Number of stamped cigarettes sold during the period (Schedule F, Line 4).........._____________________________________________________
7. Number of cigarettes returned/destroyed (and not included on
Schedule F, Line 3)................................................................................................._____________________________________________________
8. Total (Add Lines 5 through 7. This total should equal Line 4)................................_____________________________________________________
B.
SALES OF UNSTAMPED AND NY STATE STAMPED CIGARETTES IN NEW YORK CITY
9. Unstamped and NYS stamped cigarettes sold in New York City
during the period (Schedule E, Line 2).................................................................. _____________________________________________________
Form CTX-R - Cigarette Tax Report 06.08.2017
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