Form 69-110 - Texas Distributor Report Of Interstate Sales Of Cigarettes Page 2
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2Form 69-110 (Back)(Rev.8-09/6)
INSTRUCTIONS FOR COMPLETING
TEXAS DISTRIBUTOR REPORT OF INTERSTATE SALES OF CIGARETTES - PRIOR TO 09/01/09
Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you,
with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction,
contact us at the address or telephone numbers listed on this form.
GENERAL INFORMATION
Who Must File: Texas cigarette distributors who make interstate sales of cigarettes must complete a separate Texas Distributor Report
of Interstate Sales of Cigarettes for each state into which you made interstate cigarette sales during the report filing
period.
When to File: Mail the interstate sales report(s), along with your Texas Distributor Monthly Report of Cigarettes and Stamps (Form 69-100)
for the same filing period, on or before the due date listed on Form 69-100.
SPECIFIC INSTRUCTIONS
Item a - Taxpayer number - Enter your 11-digit taxpayer number as shown in Item c of the Texas Distributor Monthly Report of Cigarettes
and Stamps.
Item c - Filing period - Enter the report filing period. The filing period should be the same as the filing period shown in Item d of your Texas
Distributor Monthly Report of Cigarettes and Stamps, to which this interstate sales report is attached.
Item d - Taxpayer name - Enter your entity/taxpayer name as shown in Item g of your Texas Distributor Monthly Report of Cigarettes and
Stamps.
Item e - Physical address of permitted location - Enter the physical address of your cigarette tax permitted location. Do not use a rural
route or P.O. Box.
Item f - State of sales - Enter the name of the state into which you sold cigarettes during the filing period. Complete a separate interstate
sales report form for each applicable state.
Item 1 - Purchaser’s name and address - Enter the name, street address, city, state and ZIP Code of each out-of-state purchaser in the
“state of sales” shown in Item f.
Item 2 - Invoice date - Enter the date of the invoice that identifies the sale of cigarettes to the out-of-state purchaser listed.
Item 3 - Invoice number - Enter the invoice number that identifies the sale of cigarettes to the out-of-state purchaser listed.
Item 4 - Invoice total - Enter the total amount of each invoice issued to the out-of-state purchaser listed.
Item 5 - Number of Cigarettes - Enter the actual number of cigarettes (sticks) sold to the out-of-state purchaser for each invoice number
listed.
FOR ASSISTANCE
For questions regarding Texas cigarette tax, contact the State Comptroller at (800) 862-2260 or (512) 463-3731.
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