Form Tt-14 - Virginia Monthly Report Of Non-Resident Cigarette Stamping Agent

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TT-14

MONTHLY REPORT OF NON-RESIDENT CIGARETTE STAMPING AGENT

Virginia Department of Taxation

Name

Month/Year

Mail To:

Trading As

Permit Number

Department of Taxation

P. O. Box 715

Number and Street

Richmond, VA 23218-0715

City or Town, State, ZIP Code

Packs of 20

Packs of 25

SECTION I — Cigarette Reconciliation

1. Balance of Virginia stamped cigarette packs on hand first day of month

2. Total Virginia cigarette packs stamped during month (from Schedule D)

3. Total Virginia stamped cigarette packs (add lines 1 and 2)

4. Balance of Virginia stamped cigarette packs on hand last day of month

5. Balance of stamped cigarette packs shipped into or delivered in VA during month (from Schedule A)

SECTION II—Stamp Reconciliation

6. Balance of Virginia Cigarette Revenue Stamps on hand first day of month

7. Total Virginia Cigarette Revenue Stamps received during month (from Schedule B)

8. Total (add lines 6 and 7)

9. Total Virginia Cigarette Revenue Stamps affixed during month (from Schedule D)

10. Returns and Other Adjustments (see instructions)

11. Balance of Virginia Cigarette Revenue Stamps on hand last day of month (line 8 minus lines 9 and 10)

Report Verification and Contact Information

I, the undersigned, declare under penalties of perjury that I have examined this return and supporting schedules and to the best of my knowledge and belief, they are true, correct and

complete.

Print Name ______________________________________________________________________ Title or Position ___________________________________________________

Signature _______________________________________________________________________ Date ___________________________________________________________

Contact name ____________________________________________________________________ Telephone Number (________)_______________________________________

E-mail Address ___________________________________________________________________