Wv/tp702-Cp - Cigarette Purchaser Excise And Use Tax Report Form
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3WEST VIRGINIA STATE TAX DEPARTMENT
WV/TP702-CP
12/06
OFFICE OF BUSINESS REGISTRATION, 1001 LEE ST EAST, CHARLESTON, WV 25301
CIGARETTE PURCHASER EXCISE AND USE TAX REPORT
Any person who purchases cigarettes not bearing the WV cigarette tax stamp over the Internet, mail order catalogs or from other
cigarette retail stores located outside WV and brings the cigarettes into WV for consumption must remit the Cigarette Excise and Use
Tax to the State Tax Department. This form is provided for the purpose of computing tax due and remitting your payment to the above
address.
PERIOD ENDING
WV Identification Number or Social Security Number
/
/
Name
MONTH
DAY
YEAR
Address
Address
City, State Zip
CIGARETTE TAX CALCULATION
1.
TOTAL NUMBER OF PACKS RECEIVED
(Use the figures from schedule CP1 )
2.
TAX RATE PER PACK OF CIGARETTES
.55
3.
TOTAL EXCISE TAX DUE ON CIGARETTES
TAX CODE 08
$
,
.
USE TAX CALCULATION
$
1.
TOTAL COST OF CIGARETTES PURCHASED
(less shipping charges if separately stated)
(Use the figures from schedule CP1 )
2.
USE TAX RATE
6%
3.
TOTAL USE TAX DUE
(multiply line1 by line 2)
$
,
.
TOTAL TAX DUE WITH THIS REPORT
$
,
.
(EXCISE TAX DUE + USE TAX DUE
I hereby certify that this report, including any accompanying schedules, has been examined by me and to the best of my
knowledge and belief is a true, correct and complete report.
(
)
PRINT/TYPE NAME
SIGNATURE
DAYTIME TELEPHONE NUMBER
DATE
USE BLUE OR BLACK INK ONLY
Department Use Only
DO NOT PHOTOCOPY
Cigarette Tax Paid
$
,
.
*O50110601W*
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