Free TC-552, Utah Cigarette Stamp Report - Utah

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Utah State Tax Commission 210 N 1950 W · SLC, UT 84134 · www.tax.utah.gov

TC-552
Rev. 12/08

Utah Cigarette Stamp Report
Name and address (please correct any errors)

Federal ID Number
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
$0.695

B. PM Stamps
$0.869

C. NPM Stamps
$1.045

20s
1. Inventory of unaffixed Utah stamps at the beginning of the period .. 2. Utah stamps affixed during reporting period ............................... 3. Utah stamps spoiled or destroyed during reporting period ......... 4. Utah stamps purchased during reporting period ......................... 5. Inventory of unaffixed Utah stamps at the end of the period....... * For NPM stamps affixed during the reporting period (2C), provide the following details: 1A 2A 3A 4A 5A 1B 2B 3B 4B 5B

25s
1C 2C* 3C 4C 5C

20s

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 "Clear form" button when you are finished.
_____ _ _ _ _ _______________ _ _ _ _ _ Authorized Signature ____ _______________ Title _______________ Date

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Utah Cigarette Stamp Report Instructions
General Information
Every manufacturer, distributor, wholesaler and retailer who affixes Utah stamps to cigarette packs must file this report monthly with the Tax Commission. You must report Utah cigarette stamps according to number and denomination. See Utah Code §59-14-205 and §59-14-214.

TC-552i 11/08

If you affixed NPM stamps to packs of cigarettes, you must report the brand names and the manufacturers of the packs.

Contact Information
If you have questions about this report, contact the Tax Commission 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 Line 2 Line 3 Line 4 Line 5 Provide the number of unaffixed Utah stamps in your possession at the beginning of the month. Provide the number of Utah stamps you affixed to packs of cigarettes during the month. Provide the number of Utah stamps you were unable to affix because of damage or other spoilage. Provide the number of Utah stamps you purchased during the month. Provide the number of unaffixed Utah stamps you have at the end of the month. __________________ _ _

If you need an accommodation under the Americans with Disabilities Act, contact the Tax Commission at 801-297-3811 or TDD 801-297-2020. Please allow three working days for a response.