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Utah State Tax Commission
TC-552
210 N 1950 W • SLC, UT 84134 • www.tax.utah.gov
Rev. 12/08
Utah Cigarette Stamp Report
Federal ID Number
Name and address (please correct any errors)
Start below this line. Enter your company name and address. Use this number for
all references
Tax Period
Due Date
Check box if AMENDED and enter correct
REPORT PERIOD (above) being amended.
A. PM Stamps B. PM Stamps C. NPM Stamps
$0.695 $0.869 $1.045
20s 25s 20s
1. Inventory of unaffixed Utah stamps at the beginning of the period .. 1A 1B 1C
2. Utah stamps affixed during reporting period ............................... 2A 2B 2C*
3. Utah stamps spoiled or destroyed during reporting period ......... 3A 3B 3C
4. Utah stamps purchased during reporting period ......................... 4A 4B 4C
5. Inventory of unaffixed Utah stamps at the end of the period....... 5A 5B 5C
* For NPM stamps affixed during the reporting
period (2C), provide the following details: Brand Name Manufacturer
I declare under the penalties of perjury that, to the best of my knowledge, all of the information in this affidavit and any attached
documents is true and accurate.
IMPORTANT: To protect your privacy, use the quot;Clear formquot; button when you are finished. Clear form
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Authorized Signature Title Date Telephone

2. TC-552i 11/08
Utah Cigarette Stamp Report Instructions
General Information If you affixed NPM stamps to packs of cigarettes, you must report
the brand names and the manufacturers of the packs.
Every manufacturer, distributor, wholesaler and retailer who affixes
Utah stamps to cigarette packs must file this report monthly with
Contact Information
the Tax Commission. You must report Utah cigarette stamps
according to number and denomination. See Utah Code If you have questions about this report, contact the Tax Commis-
§59-14-205 and §59-14-214. sion at 801-297-3533, or toll free (outside the Salt Lake area) at
1-800-662-4335, ext. 3533.
Line-by-Line Instructions
Line 1 Provide the number of unaffixed Utah stamps in your
possession at the beginning of the month.
__________________ _
_
Line 2 Provide the number of Utah stamps you affixed to packs
of cigarettes during the month.
Line 3 Provide the number of Utah stamps you were unable to If you need an accommodation under the Americans with Disabili-
affix because of damage or other spoilage. ties Act, contact the Tax Commission at 801-297-3811 or TDD
801-297-2020. Please allow three working days for a response.
Line 4 Provide the number of Utah stamps you purchased
during the month.
Line 5 Provide the number of unaffixed Utah stamps you have
at the end of the month.