Form Ctx-Nr - Non-Resident Agent'S Cigarette Tax Return
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1
2FOR DEPARTMENT USE ONLY
NYC DEPARTMENT OF FINANCE ENFORCEMENT DIVISION
L.
C
HECKED BY
CTX-NR
N O N - R E S I D E N T A G E N T ’ S
D
ATE
FINANCE
R
C I G A R E T T E T A X R E T U R N
EMARKS
NEW YORK
THE CITY OF NEW YORK
DEPARTMENT OF FINANCE
n y c . g o v / f i n a n c e
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 outside the City of New York. This return must be received with the required support-
ing 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.
Month and Year: __________________ 20________
3. Street Address:
City:
State:
Zip Code:
4. E-mail Address:
5. Employer Identification Number:
6. NY State License Number:
AJ
7. NY City License Number:
SECTION II - REPORT OF NEW YORK CITY STAMPED AND UNSTAMPED CIGARETTES
Indicate the amounts of numbers 1-8 in the appropriate column.
NUMBER OF INDIVIDUAL CIGARETTES
Enter the number and size of odd-size packages in the miscellaneous column.
Packing Size
Packing Size
Packing Size
.
MISC
Example: 5’
, 24’
, 100’
, 240’
.
10
20
25
S
S
S
S ETC
SIZE
NO
A.
REPORT OF NEW YORK CITY STAMPED CIGARETTES
1. Inventory of stamped cigarettes at beginning of the month ...................................
2. Number of cigarettes stamped during the month (This number, when divided
by number of cigarettes in each package, should equal Item 6 in Section III) ......
3. Number of cigarettes received from authorized agents (with stamp affixed) .........
4. Total (Add Lines 1 through 3) .................................................................................
5. Inventory of stamped cigarettes at end of the month.............................................
6. Number of stamped cigarettes sold during the month ...........................................
7. Other.......................................................................................................................
8. Total (Add Lines 5 through 7. This total should equal total in Line 4) ....................
B.
SALES OF UNSTAMPED AND NEW YORK STATE STAMPED CIGARETTES
9. Unstamped and New York State stamped cigarettes sold in New York City
during the month (Cigarette Tax Schedule Figure E info) ......................................
SECTION III - REPORT OF CIGARETTE STAMPS
Use quantity, not the face value of stamps
NUMBER OF NYS AND NYC JOINT CIGARETTE STAMPS
$0.75
$1.50
$1.88
OTHER
1. Inventory of unaffixed stamps at the beginning of month.......................................
2. Number of stamps purchased during the month ....................................................
3. Total (Add Lines 1 and 2)........................................................................................
4. Inventory of stamps at end of the month ...............................................................
5. Number of cigarettes re-stamped ...........................................................................
6. Number of stamps affixed during the month (See Item 2 in Section II) .................
7. Total (Add numbers 4 through 6) ............................................................................
SECTION III - 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
Title
Date
Visit Finance at nyc.gov/finance
CTX-NR- 12/13/05
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