Form TC-79 "Cigarette Revenue Stamps Order Form" - Utah

What Is Form TC-79?

This is a legal form that was released by the Utah State Tax Commission - a government authority operating within Utah. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2011;
  • The latest edition provided by the Utah State Tax Commission;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form TC-79 by clicking the link below or browse more documents and templates provided by the Utah State Tax Commission.

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Download Form TC-79 "Cigarette Revenue Stamps Order Form" - Utah

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Utah State Tax Commission
210 N 1950 W • SLC, UT 84134 • www.tax.utah.gov
TC-79
Cigarette Revenue Stamps
Rev. 6/11
Order Form
Denomination or Description
Quantity
Unit Price Amount Due
Office Use Only
Small Orders 1. 20 count stamps – multiples of 240
$408.00
2. 20 count NPM stamps – multiples of 150
$307.50
Roll Orders
3. 20 count rolls – 30,000 stamps
$51,000.00
4. 20 count NPM rolls – 15,000 stamps
$30,750.00
5. 25 count rolls – 7,200 stamps (M-12 across)
$15,300.00
6. 25 count NPM rolls – 7,200 stamps
$18,450.00
7.
Subtotal (Add lines 1 through 6. Discount applies to this subtotal.)
$
Date filled
8.
Discount (Multiply line 7 by .04)
9.
Net Tax (Line 7 minus line 8)
Order filled by:
Delivery Instructions
Check one:
Will call
Special Handling
Carrier: _ _ ___ _ ___ ___ ___ __ _____________
Carrier Account number: ______ _ __ __ _
Deliver stamps to (enter name):__ __ __________________________________ __ _ __ __
 
Enter delivery address, if different than below:________________________________ _ __ __ _
 
Signature of person receiving stamps: __ __ _______________________ Date: ____ _ __ __ _ _
License Holder Information
Name:
_ _ _ __ __ _ __ ___ ___ __ ___ ___________ Account number: ____________ __ _ __ _
Address:
___________________________________________________________
City:
__ _ _ __ __ _ __ ___ ___ __ ___ ________
State:
______
ZIP Code:
______________
Contact Person
Name:
_ _ _ __ __ _ __ ___ ___ __ ___ _____
Email address: _________________________
Signature
If this order is purchased on credit, the license holder agrees to pay the total amount due within 60 days of the date filed.
_ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ _____
______________
________________
License holder
Phone
Date
Mail or deliver this order form to:
Cigarette Stamps
Amount Paid
Utah State Tax Commission
210 North 1950 West
IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.
Salt Lake City, UT 84134
Clear form
Clear form
Print Form
Utah State Tax Commission
210 N 1950 W • SLC, UT 84134 • www.tax.utah.gov
TC-79
Cigarette Revenue Stamps
Rev. 6/11
Order Form
Denomination or Description
Quantity
Unit Price Amount Due
Office Use Only
Small Orders 1. 20 count stamps – multiples of 240
$408.00
2. 20 count NPM stamps – multiples of 150
$307.50
Roll Orders
3. 20 count rolls – 30,000 stamps
$51,000.00
4. 20 count NPM rolls – 15,000 stamps
$30,750.00
5. 25 count rolls – 7,200 stamps (M-12 across)
$15,300.00
6. 25 count NPM rolls – 7,200 stamps
$18,450.00
7.
Subtotal (Add lines 1 through 6. Discount applies to this subtotal.)
$
Date filled
8.
Discount (Multiply line 7 by .04)
9.
Net Tax (Line 7 minus line 8)
Order filled by:
Delivery Instructions
Check one:
Will call
Special Handling
Carrier: _ _ ___ _ ___ ___ ___ __ _____________
Carrier Account number: ______ _ __ __ _
Deliver stamps to (enter name):__ __ __________________________________ __ _ __ __
 
Enter delivery address, if different than below:________________________________ _ __ __ _
 
Signature of person receiving stamps: __ __ _______________________ Date: ____ _ __ __ _ _
License Holder Information
Name:
_ _ _ __ __ _ __ ___ ___ __ ___ ___________ Account number: ____________ __ _ __ _
Address:
___________________________________________________________
City:
__ _ _ __ __ _ __ ___ ___ __ ___ ________
State:
______
ZIP Code:
______________
Contact Person
Name:
_ _ _ __ __ _ __ ___ ___ __ ___ _____
Email address: _________________________
Signature
If this order is purchased on credit, the license holder agrees to pay the total amount due within 60 days of the date filed.
_ __ __ __ _ __ _ _ _ __ ___ ___ __ ___ _____
______________
________________
License holder
Phone
Date
Mail or deliver this order form to:
Cigarette Stamps
Amount Paid
Utah State Tax Commission
210 North 1950 West
IMPORTANT: To protect your privacy, use the "Clear form" button when you are finished.
Salt Lake City, UT 84134
Clear form
Instructions for TC-79
TC-79_i
General Instructions
Distributor Information
Mail or deliver this return and the tax due to the Utah State Tax Commission,
Utah Code §59-14-206 authorizes the Tax Commission to sell cigarette stamps
210 North 1950 West, Salt Lake City, UT 84134.
to persons holding a valid cigarette license. Unused stamps may be redeemed
within two years of purchase.
Definitions
If you have a sufficient bond, you may buy stamps on credit for a period of up to 60
“Cigarette” means any roll for smoking made wholly or in part of tobacco,
days. The face value of stamps bought on credit may not exceed 90 percent of your
irrespective of size or shape, and whether or not such tobacco is flavored,
bond. Requests to buy stamps on credit must be signed by the licensee in the case
adulterated, or mixed with any other ingredient, the wrapper or cover of which
of individual ownership, a partner in the case of a partnership, or an authorized
is made of paper or any other substance or material except tobacco.
officer of the corporation in the case of a corporation.
“Nonparticipating manufacturer” (NPM) means a tobacco product manufac-
Keep a copy of this form for your records. A receipt with a payment coupon will
turer that is not a participant in the Master Settlement Agreement entered into
be returned with the stamp order. When making payment on a credit order,
on Nov. 23, 1998 by the State of Utah and leading U.S. tobacco product
enter the amount being remitted on the payment coupon and return with your
manufacturers.
payment to the Tax Commission.
To identify NPM products, see the Utah Cigarette Directory at
If you have questions, contact the Utah State Tax Commission at
tax.utah.gov/cigarette/cig-directory.pdf. NPM products are highlighted and
801-297-2200 or 1-800-662-4335 if outside the Salt Lake area. You may also
identified by brand name.
visit our website at tax.utah.gov.
“Participating manufacturers” are those other than “nonparticipating
manufacturers.”
______________________
If you need accommodations 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.
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