Form Ctx-R - Cigarette Tax Activity Report (Page 4 of 10) in pdf

Cigarette Activity Report

Page 2

SECTION III - REPORT OF JOINT NYS/NYC CIGARETTE STAMPS

NUMbER OF CIGARETTE STAMPS

(To be completed by Agent-Jobbers located within New York City.) Use

quantity, not the face value of stamps.

JOINT

OThER

$0.75

$1.50

$1.88

SIzE

1. Inventory of unaffixed stamps at the beginning of the period................................ _____________________________________________________

2. Number of stamps purchased during the period...................................................._____________________________________________________

3. Total(s) (Add Lines 1 and 2) .................................................................................._____________________________________________________

4. Number of Joint NYS/NYC stamps used/affixed during the period....................... _____________________________________________________

5. Number of Joint NYS/NYC stamps returned/destroyed during the period..................... _____________________________________________________

6. Total (Add Lines 4 and 5)....................................................................................... _____________________________________________________

7. Inventory of unaffixed Joint NYS/NYC stamps at the end of period

(Line 3 minus Line 6)............................................................................................. _____________________________________________________

SECTION IV - REPORT OF ALL JOINT NYS/NYC STAMPED CIGARETTES

(To be completed by all New York City Licensees.) This section should be

NUMbER OF INDIVIDUAL CIGARETTES

prepared by all licensed Agent-Jobbers, Sub-Jobbers and vending machine

Packing Size

MISC

operators.

SIzE

1. Inventory of joint NYS/NYC stamped cigarettes at the beginning of the period... _____________________________________________________

2. Number of joint NYS/NYC stamped cigarettes purchased during the period........ _____________________________________________________

3. Subtotal (Add Lines 1 and 2).................................................................................._____________________________________________________

4. Number of joint NYS/NYC stamped cigarettes sold during the period.

(Schedule F, Line 4)............................................................................................... _____________________________________________________

5. Inventory of NYS/NYC joint stamped cigarettes at the end of the period............._____________________________________________________

6. Number of joint NYS/NYC stamped cigarettes returned/destroyed during the

period (and not included in Schedule F, Line 3)....................................................._____________________________________________________

7. Total (add Lines 4 through 6)................................................................................. _____________________________________________________

8. balance to be accounted for (Line 3 minus Line 7)............................................... _____________________________________________________

SECTION V - CERTIFICATION

I, ___________________________________________________________________________________________, hereby certify that this report, together

Print Name of Owner, Partner or Corporate Officer

with accompanying schedules or statements, have been examined by me and are to the best of my knowledge and belief, true and complete and made

in good faith, for the period stated, pursuant to Title 11, Chapter 13 of the Administrative Code and the regulations issued under authority thereof.

___________________________________________________

_____________________________________________

Signature

Title

(__________) ____________________________________

__________________________________________

Telephone Number