Forms • Radford, VA • CivicEngage

Cigarette Tax Monthly Distribution Accounting Form

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Mailing Address:
Applicant:
FEIN:
Cigarette Tax Lic. #:
For the Time Period (Start Date-End Date):
Quantity of Cigarette Packs sold or delivered in Radford:
Quantity of Stamps on hand, affixed. (City of Radford stamps only)
Quantity of Stamps on hand, un-affixed. (City of Radford stamps only)
List each dealer/retailer withing the City limits of Radford to whom cigarettes were sold and the quantity sold to each: