(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