Form Tob: Use - Tobacco/playing Cards Use Tax Return - 2009

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TOB: USE

1/09

LABAMA

EPARTMENT OF

EVENUE

DEPARTMENTAL USE ONLY

Reset

, U

& B

• T

ALES

USINESS

IVISION

OBACCO

ECTION

Bank Deposit Date

P .O. Box 327556 • Montgomery, AL 36132-7556 • (334) 242-9627 •

Amount Paid

Tobacco/Playing Cards Use Tax Return

Checked By

_______________________, ________

FOR THE MONTH OF

(MONTH OF ACTIVITY)

(YEAR)

COMPANY NAME

FEIN / SSN

ADDRESS

PERMIT / REGISTRATION NUMBER

–

CITY

STATE

ZIP

TELEPHONE NUMBER

(

)

–

See Instructions and Schedule of Taxes on Reverse Side to Compute Tax.

CIGARETTES ONLY

OTP ONLY (CIGARS, LITTLE CIGARS, SMOKING TOBACCO,

PLAYING CARDS ONLY

TAX RATE .02125 / STICK

SNUFF, AND CHEWING TOBACCO. SEE INSTRUCTIONS.)

TAX RATE .10 / DECK

DATE

NAME AND ADDRESS FROM WHOM RECEIVED

RECEIVED

NO. OF SINGLE

TAX DUE

TYPE OF

NO. OF ITEMS OR

RATE OF

NO. OF

TAX DUE

STICKS

(COL. 3 X .02125)

PRODUCT

SIZE OF PKG.

TAX

PKGS.

DECKS

(COL. 10 X .10)

a. Total Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . .

b. Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . .

c. AMOUNT DUE EACH TAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cigarette Tax

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . OTP Tax

P Card Tax

d. TOTAL AMOUNT DUE EACH TAX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e. Failure to timely file penalty (Greater of 10% of TOTAL TAX or $50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f. Failure to timely pay penalty (10% of TOTAL TAX) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g. GRAND TOTAL DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Under penalties of perjury, I certify that, to the best of my knowledge, this return is true and accurate.

_________________________________________________________

______________________________

SIGNATURE

TITLE

DATE

The return along with the proper remittance is due by the 10th of the month following the preceding calendar month’s receipts of untaxed tobacco products. Failure to file the return and remit

the tax timely will result in penalties (Code of Alabama 1975, §40-2A-11) and interest (Code of Alabama 1975, §40-1-44) charges. Cash sent through the mail is sent at taxpayer’s risk.

Separate checks must be remitted for state and county payments. The original return and remittance must be mailed to the Alabama Department of Revenue at the address above.