Texas Cigarette, Cigar and Tobacco Products Report Forms-69-100 Texas Distributor Monthly Report of Cigarettes and Stamps

1. Remember to print and sign your report.
69-100
b.
(Rev.4-08/8)
PRINT FORM CLEAR FIELDS
TEXAS DISTRIBUTOR MONTHLY REPORT OF CIGARETTES AND STAMPS
You have certain rights under Chapters 552 and 559, Government Code, to review, request, and correct
a. T code 31100 information we have on file about you. Contact us at the address or toll-free number listed on this form.
c. Taxpayer number d. Filing period e. f. Due date
MONTH ENDING
h.IMPORTANT
g. Taxpayer name and tax reportyour report(Make any necessary name and address changes below)
Complete mailing address online, before printing. Blacken this box if:
your mailing address has changed,
Begin by entering your 11-digit taxpayer identification 1.
your permitted location address has changed, or
number and filing period above. you are no longer in business at this location.
i. j.
k. Location number
l. Permitted location name and address:
A CHANGE TO
A REPORT MUST BE
THE PERMITTED
LOCATION ADDRESS FILED EVEN IF THERE
WILL REQUIRE A
WAS NO ACTIVITY.
NEW PERMIT.
(See instructions)
IN TEXAS --
1. Beginning period inventory 1.
2. Total purchases during this period 2.
3. TOTAL UNSTAMPED CIGARETTES AVAILABLE (Item 1 plus Item 2) 3.
4. Sales to Native American Reservations 4.
5. Sales to federal organizations 5.
6. Cigarettes stamped for interstate sales 6.
7. Cigarettes returned to manufacturers 7.
8. Cigarettes lost in shipment 8.
9. Period ending inventory 9.
10. TOTAL DEDUCTIONS (Total of Items 4, 5, 6, 7, 8, and 9) 10.
11. TOTAL CIGARETTES STAMPED FOR TEXAS (Item 3 minus Item 10) 11.
OUT OF STATE --
12. TOTAL CIGARETTES STAMPED FOR TEXAS 12.
13. TAX ON CIGARETTES STAMPED
.
13.
(Multiply Item 11 or Item 12 by the applicable tax rate in the instructions. Enter dollars and cents.)
STAMPS PER 20 PACK STAMPS PER 25 PACK
14. Stamps on hand - beginning period inventory 14a. 14b.
15. Stamps purchased during period 15a. 15b.
16. TOTAL STAMPS AVAILABLE (Item 14 plus Item 15) 16a. 16b.
17. Stamps lost, stolen, mutilated, sold, or transferred 17a. 17b.
18. Stamps on hand - ending inventory 18a. 18b.
19. TOTAL STAMP DEDUCTION (Item 17 plus Item 18) 19a. 19b.
20. TOTAL STAMPS AFFIXED (Item 16 minus Item 19) 20a. 20b.
21. Current stamp value 21a. 21b.
. .
22. TAX VALUE (Dollars and cents) (Multiply Item 20 by Item 21) 22a. 22b.
.
23. VALUE OF STAMPS AFFIXED (Item 22a plus Item 22b) 23.
Form 69-100 (Rev.4-08/8)
.
24. PENALTY AMOUNT DUE AND PAYABLE (See instructions) 24.
Taxpayer name m. n.
T Code Taxpayer number Period I declare that the information in this document and all attachments is true and correct
to the best of my knowledge and belief.
Authorized agent
31020
Preparer's name (Please print)
Make the amount in Item 24 payable to STATE COMPTROLLER. Our
mailing address is P.O. Box 149361, Austin, TX 78714-9361. Daytime phone Date
(Area code & number)
If you have any questions regarding Cigarette Tax, you may contact the
Texas State Comptroller's field office in your area or call (800) 862-2260,
toll free nationwide. The local number in Austin is (512) 463-1693. 111 C

2. Form 69-100 (Back) (Rev.4-08/8)
INSTRUCTIONS FOR COMPLETING THE TEXAS DISTRIBUTOR
MONTHLY REPORT OF CIGARETTES AND STAMPS
GENERAL INFORMATION
WHO MUST FILE: Chapter 154 of the Tax Code provides that each distributor must submit to the Comptroller of Public Accounts,
on or before the last day of each month, a report which records purchases, cigarette, and stamp activity for the
preceding month.
Each distributor must obtain a sufficient number of stamps from the Comptroller of Public Accounts to affix to
cigarette packages prior to receipt or acceptance of the cigarettes. The distributor must affix stamps within 96
hours of receipt of the cigarettes. A distributor who possesses unstamped cigarette packages for interstate
sale must possess a sufficient number of unused stamps from the appropriate destination state to stamp the
distributor's inventory of unstamped interstate cigarettes, except for cigarette packages for which no tax is due
under federal law.
FOR ASSISTANCE: Call (800) 862-2260, toll free nationwide, or in Austin, call (512) 463-1693.
SPECIFIC INSTRUCTIONS
Item l - Permitted location - A change to the permitted location address will require you to complete and submit Form 69-121,
Business Location Supplement for Cigarette and Tobacco Products. Operating without a valid permit is subject to a
penalty of not more than $2,000 for each violation. A separate offense is committed each day on which a violation occurs.
COMPLETE ONLY ONE SECTION
- If you are located in the State of Texas, complete Items 1-11.
- If you are located outside the State of Texas, complete Item 12.
All Texas Distributor Monthly Reports of Cigarettes and Stamps must include both the Texas Distributor Receiving Record of
Cigarettes (Form 69-108) and the Texas Distributor Receiving Record of Cigarette Tax Stamps (Form 69-109).
Item 4 - Sales to Native American Reservations - must be accompanied by completed Texas Certificates of Tax Exempt Sale
(Form 69-302).
Item 5 - Sales to Federal Organizations - must be accompanied by completed Texas Certificates of Tax Exempt Sale (Form
69-302).
Item 6 - Cigarettes Stamped for Interstate Sales - must be accompanied by Texas Distributor Interstate Sales Report (Form
69-110).
Item 12 - Total cigarettes sent to Texas - should be completed ONLY by out of state distributors that are shipping quot;stamped for
Texasquot; cigarettes into Texas.
Item 13 - Multiply Item 11 or Item 12 by the applicable tax rate:
If the filing period ending is prior to January 1, 2007, multiply item 11 or 12 by .0205; tax rate = $20.50 per thousand;
If the filing period ending is after December 31, 2006, multiply item 11 or 12 by .0705; tax rate = $70.50 per thousand.
Item 17 - Stamps lost, stolen, mutilated, sold, or transferred - must be accompanied by police report, Authorization for Sale or
Transfer Cigarette Tax Stamps (Form 69-223), and/or any other documentation acceptable to the Comptroller.
Item 23 - Value of stamps affixed - should be equal to or comparable (considering monthly close out dates) to Item 13.
Item 24 - A minimum penalty of $50 is due for failure to file this report on or before the due date.
CIGARETTE DISTRIBUTOR SUPPORTING DOCUMENTATION
Form 69-108 - Texas Distributor Receiving Record of Cigarettes
Form 69-109 - Texas Distributor Receiving Record of Cigarette Tax Stamps
Form 69-110 - Texas Distributor Interstate Sales Report
Form 69-302 - Texas Certificate of Tax Exempt Sale