Maryland Cigarette Tax Form 605-C
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1SCHEDULE C - _____
FORM
Page: _____________ of ______________
MARYLAND
605-C
CIGARETTE
(Indicate Schedule No.)
Month or Period: ___________ 20 ______
TAX
License No.: ________________________
DISTRIBUTOR’S NAME:
C-1 - Packs Sold Outside Maryland (RETAIL)
(Show each state separately
ADDRESS:
C-2 - Packs Sold to Military
C-3 - Packs Sold To Others Authorized To Buy For
Resale Out Of State
Packs
Packs
Packs
Delivered to
Shipping Date
Invoice Number
Name and Address (City and State)
20’s
25’s
Other ____
Consumer By:
For more information:
Visit our Web site at or call Taxpayer Service at 410-260-7980 in Central Maryland or 1-800-638-2937 from elsewhere. Send faxes to 410-260-7924.
Mail to: Comptroller of Maryland, Revenue Administration Division, P.O. Box 2999, Annapolis, MD 21404-2999.
COM/RAD-605-C
Revised 02/13
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