Form RC-25-C Distributor's Confidential Report - Illinois

Form RC-25-C or the "Distributor's Confidential Report" is a form issued by the Illinois Department of Revenue.

Download a PDF version of the Form RC-25-C down below or find it on the Illinois Department of Revenue Forms website.

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Use your 'Mouse' or the 'Tab' key to move through the fields, use your 'Mouse' or 'Space Bar' to enable the "Check Boxes".
Illinois Department of Revenue
REV 01 FORM 910
RC-25-C
Distributor’s Confidential Report
Step 1: Identify your business
1
2
Business name: ______________________________________________________________
Account ID: __ __ __ __ __ __ __ __
3
Address: ____________________________________________________________________
Number and street
4
__________________________________________________________________________
License no: __ - __ __ __ __ __
City
State
ZIP
5
For what period are you completing this report?
__ __/__ __ __ __
Month
Year
6
Is this an amended report?
yes
no
7
Check here if your address has changed.
Step 2: Read this information
This report must be completed by all Illinois licensed distributors that import cigarettes into the United States to which Illinois
tax stamps have been affixed in the preceding month. You must provide information about your supplier, the cigarettes that were
imported and the persons to whom these cigarettes have been conveyed for resale. Your completed report will be treated as
confidential and exempt from disclosure under the Freedom of Information Act. Make a copy for your records.
Your completed Form RC-25-C must be attached to Form RC-25, Cigarette Importation Report, that is due the first day of each
month for the preceding month. Besides Form RC-25-C, you must also attach to Form RC-25:
• Form RC-25-A, Cigarette Manufacturer/Importer Certification, that certifies the manufacturer or importer has complied
with the
— packaging health warning and ingredient reporting requirements of the federal Cigarette Labeling and Advertising Act,
15 U.S.C. 1333 and 1335a; and
— provisions of Exhibit T of the Master Settlement Agreement entered in the case of People of the State of Illinois v. Philip
Morris, et al., and a statement indicating whether the manufacturer is or is not a participating tobacco manufacturer
within the meaning of Exhibit T;
• a copy of the permit issued to the person importing cigarettes into the United States under the Internal Revenue Code,
26 U.S.C. 5713; and,
• a copy of the customs form that contains the Internal Revenue Service’s cigarette tax information required by the U.S. Bureau
of Alcohol, Tobacco and Firearms.
Cigarettes exempt from these requirements:
Only cigarettes that are allowed to be imported or brought into the United States for personal use are exempt from these
requirements. Also, any cigarettes sold or intended to be sold as duty-free merchandise by a duty-free sales enterprise under
the provisions of 19 U.S.C. 1555(b) and any implementing regulations are exempt.
Penalties for noncompliance with these requirements:
Failure to comply with all requirements for imported cigarettes into Illinois may result in your distributor license being suspended
or revoked. In addition, a penalty that cannot exceed the greater of 500 percent of the retail value of the cigarettes involved
or $5,000 may also be imposed. Cigarettes that are acquired, held, owned, possessed, transported in, sold, distributed, or
imported into Illinois in violation of these requirements will be considered contraband. Contraband cigarettes may be seized and
forfeited and will be destroyed. This applies whether or not the violation was intentional. A violation is also an unlawful practice
as provided in Illinois’ Consumer Fraud and Deceptive Business Practices Act.
Under the Trademark Registration and Protection Act and the Counterfeit Trademark Act, cigarettes imported or reimported into
the United States for sale or distribution under any trade name, trade dress, or trademark that is the same as, or confusingly
similar to, any trade name, trade dress, or trademark used for cigarettes manufactured in the United States for sale or
distribution in the United States will be presumed to have been purchased outside the ordinary trade channels.
Any person may bring action for appropriate injunctive or other equitable relief for a violation of these requirements, actual
damages, interest on the damages from the date of the complaint, taxable costs, and reasonable attorney’s fees. If the violation
is found to be flagrant, the amount of recovery may be increased to an amount not to exceed three times the actual damages
sustained by the violation.
Next page
*491011110*
RC-25-C (R-04/14)
Use your 'Mouse' or the 'Tab' key to move through the fields, use your 'Mouse' or 'Space Bar' to enable the "Check Boxes".
Illinois Department of Revenue
REV 01 FORM 910
RC-25-C
Distributor’s Confidential Report
Step 1: Identify your business
1
2
Business name: ______________________________________________________________
Account ID: __ __ __ __ __ __ __ __
3
Address: ____________________________________________________________________
Number and street
4
__________________________________________________________________________
License no: __ - __ __ __ __ __
City
State
ZIP
5
For what period are you completing this report?
__ __/__ __ __ __
Month
Year
6
Is this an amended report?
yes
no
7
Check here if your address has changed.
Step 2: Read this information
This report must be completed by all Illinois licensed distributors that import cigarettes into the United States to which Illinois
tax stamps have been affixed in the preceding month. You must provide information about your supplier, the cigarettes that were
imported and the persons to whom these cigarettes have been conveyed for resale. Your completed report will be treated as
confidential and exempt from disclosure under the Freedom of Information Act. Make a copy for your records.
Your completed Form RC-25-C must be attached to Form RC-25, Cigarette Importation Report, that is due the first day of each
month for the preceding month. Besides Form RC-25-C, you must also attach to Form RC-25:
• Form RC-25-A, Cigarette Manufacturer/Importer Certification, that certifies the manufacturer or importer has complied
with the
— packaging health warning and ingredient reporting requirements of the federal Cigarette Labeling and Advertising Act,
15 U.S.C. 1333 and 1335a; and
— provisions of Exhibit T of the Master Settlement Agreement entered in the case of People of the State of Illinois v. Philip
Morris, et al., and a statement indicating whether the manufacturer is or is not a participating tobacco manufacturer
within the meaning of Exhibit T;
• a copy of the permit issued to the person importing cigarettes into the United States under the Internal Revenue Code,
26 U.S.C. 5713; and,
• a copy of the customs form that contains the Internal Revenue Service’s cigarette tax information required by the U.S. Bureau
of Alcohol, Tobacco and Firearms.
Cigarettes exempt from these requirements:
Only cigarettes that are allowed to be imported or brought into the United States for personal use are exempt from these
requirements. Also, any cigarettes sold or intended to be sold as duty-free merchandise by a duty-free sales enterprise under
the provisions of 19 U.S.C. 1555(b) and any implementing regulations are exempt.
Penalties for noncompliance with these requirements:
Failure to comply with all requirements for imported cigarettes into Illinois may result in your distributor license being suspended
or revoked. In addition, a penalty that cannot exceed the greater of 500 percent of the retail value of the cigarettes involved
or $5,000 may also be imposed. Cigarettes that are acquired, held, owned, possessed, transported in, sold, distributed, or
imported into Illinois in violation of these requirements will be considered contraband. Contraband cigarettes may be seized and
forfeited and will be destroyed. This applies whether or not the violation was intentional. A violation is also an unlawful practice
as provided in Illinois’ Consumer Fraud and Deceptive Business Practices Act.
Under the Trademark Registration and Protection Act and the Counterfeit Trademark Act, cigarettes imported or reimported into
the United States for sale or distribution under any trade name, trade dress, or trademark that is the same as, or confusingly
similar to, any trade name, trade dress, or trademark used for cigarettes manufactured in the United States for sale or
distribution in the United States will be presumed to have been purchased outside the ordinary trade channels.
Any person may bring action for appropriate injunctive or other equitable relief for a violation of these requirements, actual
damages, interest on the damages from the date of the complaint, taxable costs, and reasonable attorney’s fees. If the violation
is found to be flagrant, the amount of recovery may be increased to an amount not to exceed three times the actual damages
sustained by the violation.
Next page
*491011110*
RC-25-C (R-04/14)
Step 3: Provide your import information
If you need to identify more than provided for here, do so using the same format.
Supplier
Cigarette license no.
Brand style
No. of cigarettes
_______________________ ______________ ______________ ____________
Name:
______________________
______________ ____________
Address:
____________________________
______________ ____________
Retailer or reseller information:
___________________________________
Name:
Retailer or resellers’ Illinois sales tax
__________________________________
Address:
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
_______________________________________
Supplier
Cigarette license no.
Brand style
No. of cigarettes
_______________________ ______________ ______________ ____________
Name:
______________________
______________ ____________
Address:
____________________________
______________ ____________
Retailer or reseller information:
___________________________________
Name:
Retailer or resellers’ Illinois sales tax
__________________________________
Address:
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
_______________________________________
Supplier
Cigarette license no.
Brand style
No. of cigarettes
_______________________ ______________ ______________ ____________
Name:
______________________
______________ ____________
Address:
____________________________
______________ ____________
Retailer or reseller information:
___________________________________
Name:
Retailer or resellers’ Illinois sales tax
__________________________________
Address:
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
_______________________________________
Supplier
Cigarette license no.
Brand style
No. of cigarettes
_______________________ ______________ ______________ ____________
Name:
______________________
______________ ____________
Address:
____________________________
______________ ____________
Retailer or reseller information:
___________________________________
Name:
Retailer or resellers’ Illinois sales tax
__________________________________
Address:
Account ID: ___ ___ ___ ___ ___ ___ ___ ___
_______________________________________
Step 4: Sign below
Under penalties of perjury, I state that I have examined this schedule and all attachments and, to the best of my knowledge, it is true, correct,
and complete. I also state that such information is taken from the books and records of the business for which this schedule is filed.
_________________________________________________
____________________________________________
Distributor’s signature
Printed name of the person signing this report
__________________________
_____/_____/_________
(_____)_____ - _____________
Title of the person that signed above
Month
Day
Year
Telephone number
*491012110*
RC-25-C (R-04/14)
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