Statement of Cigarettes and Other Tobacco Products Sold and Distributed
TA-17.5.R-V

This form is entended for all agents (under agreement or not under agreement) that manufacture or import cigarettes and other tobacco products.

Notes

• Before completing this form, consult the Tobacco Tax Rate Table (TA-1-V) to find out which tobacco tax rates apply to your situation. To access form TA-1-V, click the link below.
• Dynamic forms can be completed onscreen, which saves you time and makes the calculation process easier.

Supplementary documents

TA-1-V Tobacco Tax Rate Table (applicable as of January 1, 2012)