Fillable Form Rc-25 - Cigarette Importation Report

Use your 'Mouse' or the 'Tab' key to move through the fields, use your 'Mouse' or 'Space Bar' to enable the "Check Boxes".

Illinois Department of Revenue

RC-25

Cigarette Importation Report

Step 1: Identify your business

Account ID: ___ ___ ___ ___ ___ ___ ___ ___

For what period are you filing this report?

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Month

Year

License no.: ___ - ___ ___ ___ ___ ___

Is this an amended report?

yes

Business name ____________________________________________________

Check here if your address has changed

Address __________________________________________________________

or you have made changes to the label.

Number and street

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City

State

ZIP

Step 2: List the brand and brand styles of the imported cigarettes

Brand:

Brand styles:

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Step 3: Sign below

Under penalties of perjury, I state that I have examined this report and all attachments and, to the best of my knowledge, it is true, correct, and com-

plete. I also state that such information is taken from the books and records of the business for which this report is filed.

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Distributor’s signature

Printed name of the person who signed this report

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(_____)_____ - _____________

___ ___/___ ___/___ ___ ___ ___

Title of the person who signed above Month Day Year Telephone number

Note:

Do not send any payment with this report.

*090901110*

RC-25 front (R-04/10)

This form is authorized by the Cigarette Tax and Cigarette Use Tax Acts. Disclosure of this information is REQUIRED. Failure

to provide information could result in a penalty. This form has been approved by the Forms Management Center. IL-492-4126

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Form Rc-25 - Cigarette Importation Report - 2010

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