IMPORTANT NOTICE

NORTHERN VIRGINIA CIGARETTE TAX BOARD

14150 Newbrook Drive, Suite 210, Chantilly, VA 20151
FLOOR TAX REPORTING FORM
The County of Fairfax will be increasing the local cigarette tax rate from $0.30 to $0.40 effective July 1, 2024.

Code of Virginia $58.1-3830.D requires that you complete a report listing the count of your unsold inventory as of the end of the day Sunday, June 30, 2024.

The form below must be completed and submitted to our office any time between July 1 and December 31, 2024, and payment may be submitted with the completed form or by separately by June 30, 2025.

If the report is not received by December 31, 2024, the NVCTB will process a statutory assessment of the tax required and issue a notice of such assessment with a demand for immediate payment of the tax including penalties and interest.

Mail completed form & payment to:

Northern Virginia Cigarette Tax Board: 14150 Newbrook Drive, Suite 210, Chantilly, VA 20151 or email it to info@nvctb.org.

Make checks payable to: Northern Virginia Cigarette Tax Board.
Retailer Name*
Address*

City, State and Zip Code
Phone Number*
Email Address
example@example.com
UNSOLD CIGARETTE INVENTORY ON HAND AS OF COB: Sunday, June 30, 2024
Total packs on hand as of close of business June 30, 2024*
TOTAL TAX ALREADY PAID
TOTAL TAX DUE AS A RESULT OF THE TAX RATE INCREASE
TOTAL TAX AMOUNT DUE (Remit this amount to the NVCTB)
Please make check payable to: Northern Virginia Cigarette Tax Board

By signing below, I certify that the information provided in this document is true, accurate and complete. I understand that this completed form must be submitted to the NVCTB by December 31, 2024 and payment by
Signature of Preparer*

Clear
Printed Name of Preparer is below
Name of Preparer*

First NameLast Name
Date

MonthDayYear
Date
Should be Empty:

NORTHERN VIRGINIA CIGARETTE TAX BOARD

FLOOR TAX REPORTING FORM