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.

Note

Before completing this form, consult the Tobacco Tax Rate Table (TA-1-V) to find out which tobacco tax rates apply to your situation.

Note

To complete the form, save it to your computer and open it in Adobe Reader.

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Note

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2012-02 version

PDF Document (101 KB) / TA-17.5.R-V / 2012-02 version