Form Au-930 - Cigarette Inventory Report - 2003
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1Department of Revenue Services
AU-930
State of Connecticut
PO Box 2997
Cigarette Inventory Report
Hartford CT 06104-2997
CT Tax Registration Number
Packages of cigarettes on hand as of close of business
TAX TYPE
on March 14, 2003, that have an old Connecticut cigarette
License Number
tax stamp affixed
Federal Employer ID Number
(Rev. 03/03)
This report is to be filed
Please change name and address if shown incorrectly below.
by all
Licensed Cigarette
Distributors and Dealers
NO LATER THAN
April 15, 2003
Inventory of Packages of Cigarettes, on Hand as of Close of Business on March 14, 2003, That Have an Old Connecticut
Cigarette Tax Stamp Affixed.
Report the number of packages of cigarettes (including those in cartons) on hand as of the close of
business on March 14, 2003, that have a green $1.11 Connecticut cigarette tax stamp (for packages of 20 cigarettes), or that have a blue
$1.3875 Connecticut cigarette tax stamp (for packages of 25 cigarettes), affixed. This inventory must also include promotional packages
of cigarettes that have an old cigarette tax stamp affixed. If your business closes after 11:59 p.m. on March 14, 2003, your inventory must
be taken as of 11:59 p.m. on March 14, 2003. You must immediately enter this information below, sign and date Form AU-930.
You must file Form AU-930 with the Department of Revenue of Services (DRS) no later than April 15, 2003. Form AU-930 must be
filed whether or not you have cigarettes in your inventory as of the close of business on March 14, 2003, that have an old Connecticut
cigarette tax stamp affixed. Failure to do so is sufficient cause to revoke your cigarette license. See IP 2003(7), Q & A on the
Cigarette Tax Increase for Licensed Cigarette Dealers , or IP 2003(8), Q & A on the Cigarette Tax Increase for Licensed Cigarette
Distributors, for more information. Keep a copy of your signed report on your premises for inspection by DRS agents. For
additional information or assistance, call the Excise/Public Services Taxes Subdivision of the Audit Division at 860-541-3225,
Monday through Friday, 8:00 a.m. to 5:00 p.m.
Totals
Quantity
Tax Rate
( Quantity multiplied by tax rate )
For
1. Number of cartons (10 packages per carton)
x
$4.00
$
packages
that
2. Number of cartons (5 packages per carton)
x
$2.00
$
contain
20
3. Number of single packages
x
$0.40
$
cigarettes
For
4. Number of cartons (10 packages per carton)
x
$5.00
$
packages
that
5. Number of cartons (8 packages per carton)
x
$4.00
$
contain
25
6. Number of single packages
x
$0.50
$
cigarettes
7. Total tax due (Add Lines 1 through 6)
$
8. Interest for late filing (Multiply Line 7 by 1% (.01) per month or fraction of a month)
$
(Multiply Line 7 by 10% (.10) or
9. Penalty for incomplete or late filed report
$
add $50.00, whichever is greater)
10. Total Amount Due (Add Lines 7, 8 and 9)
$
Make your check or money order payable to: Commissioner of Revenue Services.
Declaration: I declare under penalty of law that I have examined this report and, to the best of my knowledge and belief, it is true,
complete, and correct. I understand that the penalty for willfully delivering a false document to DRS is a fine of not more than $5,000,
or imprisonment for not more than five years, or both.
Signature
Date
Print Name
Title
Phone Number
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