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ORIGINAL DUPLICATE TRIPLICATE

(For the Payer) (To be sent to the Luxury Tax (For the Treasury)
Department) FORM 10
FORM 10
FORM 10
[See rule 16(2)] [See rule 16(2)] [See rule 16(2)]
Chalan Chalan Chalan
(In respect of payment made (In respect of payment made (In respect of payment made
otherwise than with the return) otherwise than with the return) otherwise than with the return)
THE MAHARASHTRA TAX ON THE MAHARASHTRA TAX ON THE MAHARASHTRA TAX ON
LUXURIES ACT, 1987 LUXURIES ACT, 1987 LUXURIES ACT, 1987
(See rule 16 of the Maharashtra (See rule 16 of the Maharashtra (See rule 16 of the Maharashtra
Tax on Luxuries Rules, 1987) Tax on Luxuries Rules, 1987) Tax on Luxuries Rules, 1987)
0045, Other Taxes and Duties 0045, Other Taxes and Duties 0045, Other Taxes and Duties
on Commodities and Services- on Commodities and Services- on Commodities and Services-
105, Luxury Tax. (ii) Tax 105, Luxury Tax. (ii) Tax 105, Luxury Tax. (ii) Tax
Collected on items of luxuries Collected on items of luxuries Collected on items of luxuries
covered under the Maharashrtra covered under the Maharashrtra covered under the Maharashrtra
Tax on Laxuries Act, 1987. Tax on Laxuries Act, 1987. Tax on Laxuries Act, 1987.
Chalan of tax/interest/penalty/ Chalan of tax/interest/penalty/ Chalan of tax/interest/penalty/
forfeited amount/composition forfeited amount/composition forfeited amount/composition
money/fine paid for the period money/fine paid for the period money/fine paid for the period
from ................. to .......... from ............... to ............. from ................ to.........
By whom Payment on Amount By whom Payment on Amount By whom Pay ment on Amount
Tendered Account of (in figures) Tendered Account of (in figures) Tendered Account of (in figures)
(in Rs.) (in Rs.) (in Rs.)
(tick mark whichever (tick mark whichever (tick mark whichever
applicable) applicable) applicable)
Name and full address of the Name and full address of the Name and full address of the
Person on whose behalf Money is Person on whose behalf Money is Person on whose behalf Money is
paid ..................... (a) Tax............... paid..................... (a) Tax ................ paid..................... (a) Tax ................
(b) Interest ........ (b) Interest........... (b) Interest...........
u/s. 16 (2) u/s. 16 (2) u/s. 16 (2)
(c) Penalty......... (c) Penalty ........... (c) Penalty...........
u/s. 16(1) u/s. 16(1) Luxury u/s. 16(1) Luxury
Luxury Tax Tax Tax
(d) Penalty......... (d) Penalty........... (d) Penalty...........
R.C. No...............u/s. 17................. R.C. No. ............. u/s. 17 ................. R.C. No. ............. u/s. 17 .................
1. Form 10 was deleted by G.N. F.D. No. LTR. 1195/CR-88/Taxation-1 dated 30-9-1995, w.e.f. 1-
10-95.
B S.T.R C No. (e) Amount B S.T.R C No. (e) B S.T.R C No. (e)
(if held). forfeited. (if held). Amount.forfeite (if held). Amount.forfeite
d. d.
(f) Composition (f) Composition (f) Composition
money. money. money.
(g) Fine. (g) Fine. (g) Fine.
........................... ........................... ...........................
Total Rs............................................ Total Rs............................................ Total Rs............................................
Rupees (in Rupees (in Rupees (in
words) words) words)
........................... ........................... ...........................
......... ......... .........
Place.......Signature of the Hotelier/ Place.......Signature of the Hotelier/ Place......Signature of the Hotelier/
Textile Tra-. Textile Tra- Textile Tra-
Dated ....der/Tobacconist or Dated.....der/Tobacconist or Dated.....der/Tobacconist or
depositor depositor depositor
(For Treasury use only) (For Treasury use only) (For Treasury use only)
Received Payment of Rs.......(in Received Payment of Rs..........(in Received Payment of Rs...........(in
figures) figures) figures)
Rupees.) ............................................ Rupees.) ............................................ Rupees )........................................(in
(in words) (in words) words)
Date of entry. ..................... Date of entry. ..................... Date of entry. .....................
Chalan No.. ..................... Chalan No.. ..................... Chalan No.. .....................
Treasury Officer/Treasurer/ Treasury Officer/Treasurer/ Treasury Officer/Treasurer/
Accountant Agent/Manager Accountant Agent/Manager Accountant Agent/Manager