This document is a quarterly report form for cigarette and roll-your-own tobacco product distributors in Utah. It requires distributors to provide information about the cigarette and tobacco products they sold in Utah during the reporting period, including brands, package sizes, and quantities. Distributors must also specify whether the products sold were from participating manufacturers, non-participating manufacturers, or were imported. The completed form and accompanying schedules are due to the Utah State Tax Commission within 30 days of the end of the reporting quarter.

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Utah State Tax Commission
TC-562
Quarterly Report of
Cigarette/RYO Products
FEIN
Start below this line. Enter your company name and address.
Use this number for
all references
Report Period
Due Date
Check box if AMENDED and enter correct
REPORT PERIOD (above) being amended.
NOTE: This report must be filed on or before the 30th day of the month following the report period. Attach Schedules A, B and C. The report is
due even if there are no sales during the quarter. You must fill out the report completely and accurately for it to be deemed timely-filed. See
Utah Code §§59-14-407 and 606.
Distributor Information
_____________________ _ _
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__________
____ _ _ _ _ ______________
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____________
Correspondence Address
_______ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _________
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__________________________
Report Information
_____________________________
_________________ _ _ _ _ _
______ __________________________
A. Cigarettes B. Stick Equiv. of RYO C. Total
+ =
(from Schedule A)
+ =
(from Schedule B)
+ =
(from Schedule C)
__
_ ____________________________ ___________
__________ _____
_ _ _ _ ________
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IMPORTANT: To protect your privacy, use the quot;Clear formquot; button when you are finished. Clear form

2. TC-562_2 10/08
Instructions for Quarterly Report of Cigarette/RYO Products
General Instructions Form Instructions
Note:
Distributor Information, Correspondence Address and Report
-
Information.
Definitions
Cigarettes:
Filing the Report
Refold this form so the address below shows through the envelope
window.
Importer:
Non-Participating Tobacco Products Manufacturer (NPM):
Brand Family:
Roll-Your-Own (RYO): ___________
_ _ _ _ _ _ _ _ _ _ __
Publication 51: tax.utah.gov/forms/pubs/pub-51.pdf
UTAH STATE TAX COMMISSION
SALES TAX - TOBACCO PRODUCTS
210 N 1950 W
SLC UT 84134-3500

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TC-562A
Quarterly Report of Cigarette / RYO Products
Schedule A — Non-Participating Manufacturer Rev. 12/08
(NPM) Products Sold In Utah
Company name:
Page ____ of _ _
__
FEIN: Filing period:
Check this box if you did not sell any NPM products in Utah this filing period.
A. Manufacturer Information B. Supplier Information
______________________________ ______________________________
_____________________________ _____________________________
_______________ ____ _________ _______________ ____ _________
Cigarettes RYO
1. NPM Brand 2. Number 3. Package 4. Cigarette 5. Ounces 6. Stick 7. Total 8. Purchaser’s
Name of Packs Size Sticks of RYO Equiv. Sticks Name and Address
Sold Sold of RYO Sold
Totals
A. Manufacturer Information B. Supplier Information
______________________________ ______________________________
_____________________________ _____________________________
_______________ ____ _________ _______________ ____ _________
Cigarettes RYO
1. NPM Brand 2. Number 3. Package 4. Cigarette 5. Ounces 6. Stick 7. Total 8. Purchaser’s
Name of Packs Size Sticks of RYO Equiv. Sticks Name and Address
Sold Sold of RYO Sold
Totals
Print Form
Attach additional pages, as needed.
IMPORTANT: To protect your privacy, use the quot;Clear formquot; button when you are finished. Clear form

4. TC-562A_2 10/08
Instructions for TC-562 Schedule A
General Instructions
Schedule Instructions

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Utah State Tax Commission • 210 N 1950 W • Salt Lake City, UT 84134 • www.tax.utah.gov
TC-562B
Quarterly Report of Cigarette / RYO Products
Schedule B — Participating Manufacturer Rev. 12/08
(PM) Products Sold In Utah
Company name:
Page ____ of _ _
__
FEIN: Filing period:
Check this box if you did not sell any PM products in Utah this filing period.
Check this box if you did not affix stamps to products you sold in Utah.
Check this box if you did not pay the tobacco tax for tobacco products you sold in Utah.
Complete only if you affix PM stamps to packs. Complete only if you pay the tobacco tax (reported
Do not complete this section if you buy packs on TC-553). Do not complete if you buy RYO on
that are already stamped. which the tax has already been paid.
Cigarettes RYO
1. PM Brand Name 2. Number 3. Package 4. Cigarette 5. Ounces 6. Stick Equiv. 7. Total
of Packs Size Sticks Sold of RYO Sold of RYO Sticks Sold
Totals
Attach additional pages, as needed.
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IMPORTANT: To protect your privacy, use the quot;Clear formquot; button when you are finished. Clear form

6. TC-553M_2 Rev. 4/07
Instructions for TC-562 Schedule B
General Instructions Column 2 Enter the number of packs of cigarettes sold. DO NOT
complete this section if you by packs that are already
You must file Schedule B even if you have nothing to report. If you do not
stamped.
Column 3 Enter the number of cigarettes per pack.
nothing to report and enter zeros “0” on TC-562 line 2.
Column 4 Enter the total cigarette sticks sold (multiply column 2 by
column 3). Total the amounts in column 4 at the bottom of
Schedule B’s. Copies must match the original schedule exactly. Enter the
page sequence in the space provided (upper-right corner of the
column A.
schedule).
Column 5 Enter the number of ounces of RYO (roll-your-own) sold. DO
Attach all Schedule B’s to TC-562.
NOT complete this section if you buy RYO on which the tax
has already been paid.
Schedule Instructions
cigarette). Enter the total in column 6. Total the amounts in
Column 1 Enter the quot;brand familyquot; under which the product is
column 6 at the bottom of the column. Enter this amount on
styles of each brand as total sales of that brand. Column 7 Add column 4 and column 6. Enter the total in column 7.

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TC-562C
Quarterly Report of Cigarette / Tobacco Products
Schedule C — Imported Products Sold In Utah Rev. 10/08
Company name:
Page ____ of _ _
__
FEIN: Filing period:
Only file this schedule if you recieve products that are shipped from a
location that is not a U.S. territory.
Check this box if you did not sell any imported products in Utah this quarter.
A. Manufacturer Information B. Importer Information C. Supplier Information
__ ___________________ ___________________
__ __________________ __________________
___________________ __ _ _ _ _ _ _ _ _ _
_________ _____
_ _ _ _ ___________
__________________ __
__ ______
_____ __
__ ___________
__________ _ _ _ _ _
_____ _______
_______
____ ___________ _______
1. Brand Name 2. Number 3. Package 4. Cigarette 5. Ounces 6. Stick 7. Total 8. Purchaser’s
and Style of Packs Size Sticks of RYO Equiv. Sticks Name and Address
Sold Sold of RYO Sold
Totals
A. Manufacturer Information B. Importer Information C. Supplier Information
__ ___________________ ___________________
__ __________________ __________________
___________________ __ _ _ _ _ _ _ _ _ _
_________ _____
_ _ _ _ ___________
__________________ __
__ ______
_____ __
__ ___________
__________ _ _ _ _ _
_____ _______
_______
____ ___________ _______
1. Brand Name 2. Number 3. Package 4. Cigarette 5. Ounces 6. Stick 7. Total 8. Purchaser’s
and Style of Packs Size Sticks of RYO Equiv. Sticks Name and Address
Sold Sold of RYO Sold
Totals
Print Form
Attach additional pages, as needed.
IMPORTANT: To protect your privacy, use the quot;Clear formquot; button when you are finished. Clear form

8. TC-562C_2 10/08
Instructions for TC-562 Schedule C
General Instructions
Only file this schedule if you recieve products that are shipped from
a location that is not a U.S. territory.
tax.utah.gov/forms/pubs/pub-51.pdf
Schedule Instructions