FOR DEPARTMENT USE ONLY
NYC DEPARTMENT OF FINANCE ● ENFORCEMENT DIVISION
L.
FINANCE
NEW
YORK
THE CITY OF NEW YORK
CHECKED
CTX-R
RESIDENT AGENT’S
CIGARETTE TAX RETURN
●
BY
DATE
REMARKS
DEPARTMENT OF FINANCE
Mail to: NYC Department of Finance, Enforcement Division, Cigarette Tax Unit, 345 Adams Street, 13th Floor, Brooklyn, NY 11201
Complete this return if you are an agent located within the City of New York. This return must be received with the required supporting Cigarette Tax schedule attached, within 15 days after the reporting period (month and year) indicated in Section I, Item 2.
SECTION I - AGENT INFORMATION
1. Name:
2. Reporting Period.
3. Street Address:
Month and Year: __________________ 20________
State:
Zip Code:
City:
4. E-mail Address:
5. Employer Identification Number:
6. NY State License Number:
7. NY City License Number:
AJ
SECTION II - REPORT OF UNSTAMPED AND NEW YORK STATE STAMPED CIGARETTES
Indicate the amounts of numbers 1-10 in the appropriate column.
Enter the number and size of odd size packages in the miscellaneous column.
Example: 5’S, 24’S, 100’S, 240’S ETC.
1.
2.
Inventory of unstamped cigarettes at beginning of the month ...............................
Number of cigarettes manufactured, purchased or
otherwise acquired (Cigarette Tax Schedule, Section II-A)....................................
3.
Total(s) (Add Lines 1 and 2) ...................................................................................
4.
5.
Sales made to exempt agencies. (Cigarette Tax Schedule, Section II-B) .............
Sales delivered and transfer(s) made to points outside the
State of New York. (Cigarette Tax Schedule, Schedule II-C) .................................
Sales delivered and transfer(s) made to points outside the
City but within the State of New York. (Cigarette Tax Schedule, Section II-D) ......
Sales delivered and transfer(s) made to other dealers within
the City. (Cigarette Tax Schedule, Section II E) .....................................................
6.
7.
8.
Other.......................................................................................................................
9.
Inventory at end of the month ................................................................................
NUMBER OF INDIVIDUAL CIGARETTES
Packing Size
10
Packing Size
20
Packing Size
25
MISC.
SIZE
NO
10. Total (Add Lines 4 through line 9) ..........................................................................
11. Balance to be accounted for (Line 3 minus Line 10) .............................................
SECTION III - REPORT OF CIGARETTE STAMPS
Use quantity, not the face value of stamps
NUMBER OF CIGARETTE STAMPS
1.
Inventory of unaffixed stamps at the beginning of the month ................................
2.
Number of stamps purchased during the month....................................................
3.
Total(s) (Add Lines 1 and 2) ..................................................................................
4.
Inventory of unaffixed stamps and restamping, if any, at end of month ...............
5.
Number of stamps used during the month (Line 3 minus Line 4) .................................
JOINT
JOINT
JOINT
$0.75
$1.50
$1.88
OTHER
SECTION IV - CERTIFICATION
I, ___________________________________________________________________________________________, hereby certify that this return, together
Print Name of Owner, Partner or Corporate Officer
with the 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
Visit Finance at nyc.gov/finance
_____________________________________________
Title
______________________
Date
CTX-R- 12/13/05
NYC DEPARTMENT OF FINANCE
●
ENFORCEMENT DIVISION
CIGARETTE TAX SCHEDULE
FINANCE
NEW
YORK
THE CITY OF NEW YORK
●
DEPARTMENT OF FINANCE
Mail to: NYC Department of Finance, Enforcement Division, Cigarette Tax Unit, 345 Adams Street, 13th Floor, Brooklyn, NY 11201
Use this form to summarize NYS stamped or unstamped cigarettes, either manufactured, purchased or otherwise acquired; NYS stamped cigarettes sold or transferred to exempt
agencies or those sold, transferred from NYC to points outside the State of New York. This tax schedule must accompany the CTX-R or CTX-NR application. See Section II.
SECTION I - AGENT INFORMATION
1. Name:
2. Reporting Period.
Month and Year: __________________ 20________
State:
Zip Code:
3. Street Address:
City:
4. E-mail
Address:
5. NY State License Number:
6. NY City License Number
AJ
SECTION II - CIGARETTE SALES AND PURCHASES INFORMATION
Please indicate type of cigarette sales or purchases you are reporting by checking one of the choices below and completing the appropriate column in the table.
Check one:
C.
❑
❑
❑
D.
❑
E.
❑
A.
B.
Unstamped and NY State Stamped Cigarettes Manufactured, Purchased or Otherwise Acquired. Complete columns 1 and 3. (Submit with CTX-R)
Sales of Unstamped Cigarettes To Exempt Agencies Complete columns 2 and 3. (Submit with CTX-R)
Unstamped and NY State Stamped Cigarettes Sold, Transferred and Delivered from NYC to Points Outside the State of New York. Complete columns 2, 3 and 4.
(Enter total in CTX-R or CTX-NR)
Unstamped and NY State Stamped Cigarettes Sold, Transferred and Delivered from NYC to Points Outside the City but within the State of New York. Complete
columns 2, 3 and 4. (Enter total in form CTX-R) - Destination must be included. See Section III on this application.
Unstamped and NY State Stamped Cigarettes Sold, Transferred and Delivered to Other Dealers Within the City of New York. Complete columns 2 and 3. (Submit with
CTX-R and CTX-NR) - Include sales of cigarettes to dealers for resale outside the City and returns of all cigarettes to all manufacturers, and others within the City.
1
2
Purchased From
Name/Street Address City/State/Zip Code
1.
2.
3.
4.
5.
6.
7.
Sold to Transferred or Returned
Name/Street Address City/State/Zip Code
Name
Name
Street Address
Street Address
City/State/Zip Code
City/State/Zip Code
Name
Name
Street Address
Street Address
City/State/Zip Code
City/State/Zip Code
Name
Name
Street Address
Street Address
City/State/Zip Code
City/State/Zip Code
Name
Name
Street Address
Street Address
City/State/Zip Code
City/State/Zip Code
Name
Name
Street Address
Street Address
City/State/Zip Code
City/State/Zip Code
Name
Name
Street Address
Street Address
City/State/Zip Code
City/State/Zip Code
Name
Name
Street Address
Street Address
3
Number of Individual Cigarettes
PACKING PACKING PACKING
SIZE
SIZE
SIZE
10’s
20’s
25’s
Misc.
4
Indicate if
NYC
tax paid
YES or NO
City/State/Zip Code
City/State/Zip Code
USE ADDITIONAL SHEET(S) IF NECESSARY
TOTAL:
SECTION III - DESTINATION INFORMATION
1. If you checked “D” above, complete columns 2, 3 and 4 and indicate the city of destination in this space. Use a separate application for each city.
Destination City: _______________________________________________________________________________________________________________
Visit Finance at nyc.gov/finance
CTX-sched 09/06/05