Form CT-10R Fillable Cigarette and Tobacco Products Retailers VT Floor Stock Tax Return (for RETAILERS)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

(If you have 0 stock enter 0 on Line 10 and go to Part III Otherwise complete Lines 9 11 ) (If you have 0 stock enter 0 on Line 7 and go to Part II Otherwise complete Lines 1 8 ) 10 Total ounces of roll your own in stock 11 Total floor stock tax due on roll your own (Multiply Line 10 by $0 585) 11 12 Enter amount from Line 8 12 13 Enter amount from Line 11 13 14 Total (Add Lines 12 and 13) 14 15 Discount If paid by the due date multiply Line 14 by 2 3% 16 TOTAL FLOOR STOCK TAX DUE (Subtract Line 15 from Line 14) 1a Packs of 20 x 20 = 1b 2a Packs of 25 x 25 = 2b 3 Total Cigarettes in Stock (Add Lines 1b and 2b) 3 4a Packs of 20 x 20 = 4b 5 Packs other than 20 (enter total number of sticks) 5 6 Total little cigars (Add Lines 4b and 5) 6 7 Total sticks (Add Lines 3 and 6) 7 8 Total floor stock tax due on cigarettes and little cigars 9 Total retail price of roll your own in stock 9 If Line 7 is 10 001 or more multiply Line 7 by $0 019 8 If Line 9 is $500 00 or less enter 0 If Line 9 is $500 01 or more enter total ounces of roll your own in stock 10 Make checks payable to Vermont Department of Taxes 16 Montpelier VT 05601 0547 PO Box 547 $500 01 or more then enter the total number of ounces of (Rev 6/11) Address as of 12:01 a m July 1 2011 CIGARETTE AND TOBACCO PRODUCTS RETAILERS Cigarettes in stock as of July 1 2011 City State ZIP Code Complete only one return for each business entity Contact Person Telephone Number correct and complete CT 10R d/b/a or Trade Name DUE DATE: July 25 2011 FORM CT 10R If Line 7 is 10 000 or less enter 0 Line 10 If the retail price on Line 9 is $500 00 or less then Line 11 Enter the total floor stock tax on roll your own by Line 12 Enter the amount from Line 8 the total floor stock Line 13 Enter the amount from Line 11 the total floor stock Line 14 Add lines 12 and 13 Line 15 from Line 14 Line 15 Multiply the discount of 2 3% by Line 14 if you Line 16 Enter the total floor stock tax due by subtracting Line 9 Enter the total retail price of roll your own in stock Line by Line Instructions List VT Business Account Number for EACH Retail Location below Attach additional sheet if necessary Little Cigars in stock as of July 1 2011 multiplying Line 10 x $0 585 No floor stock tax is due from business entities holding 10 000 No tax is due from business entities holding $500 00 or less or fewer cigarettes and little cigars at 12:01 a m July 1 2011 Otherwise enter 0 15 Part I Cigarettes and Little Cigars Part I CIGARETTES AND LITTLE CIGARS in stock as of July 1 2011 Part II Roll Your Own Part II ROLL YOUR OWN in stock as of July 1 2011 Part III Floor Stock Tax Due Part III TOTAL FLOOR STOCK TAX DUE Part IV SIGNATURE pay the floor stock tax by July 25 2011 Otherwise enter 0 Phone: (802) 828 2551 Please send completed return to: Vermont Department of Taxes Printed Name Title Retail Locations retail price of roll your own at 12:01 a m July 1 2011 roll your own in stock Signature Date tax due on cigarettes and little cigars tax due on roll your own THIS RETURN MUST BE FILED EVEN IF NO TAX IS DUE Total Cigarettes and Little Cigars Total Number of Under penalties of perjury I have examined the above information and to the best of my knowledge and belief it is true Vermont Vermont Department of Taxes PO Box 547 Montpelier VT 05601 0547 VT FLOOR STOCK TAX RETURN you do not owe any tax and enter 0 If the retail price is