Form Tob: T-220a - Monthly State Tobacco Tax Return By Nonresident Distributors

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OFFICE USE ONLY

TOB: T-220A

1/09

LABAMA

EPARTMENT OF

EVENUE

Certificate Date: _____________

, U

& B

ALES

USINESS

IVISION

Reset

Certificate No.: ______________

OBACCO

ECTION

Amount Paid: ________________

P.O. B

327556 • M

, AL 36132-7556 • (334) 242-9627

ONTGOMERY

Checked By: ________________

Monthly State Tobacco Tax Return By Nonresident Distributors

For the Month of _______________________, __________

(MONTH)

(YEAR)

NAME (PERSON, FIRM, OR CORPORATION)

FEIN / SSN

ADDRESS

PERMIT / REGISTRATION NUMBER

CITY

STATE

ZIP

TELEPHONE NUMBER

(

)

TOBACCO PRODUCTS OTHER THAN CIGARETTES ACTUALLY SOLD INTO ALABAMA DURING THE MONTH

You must complete tax information for each product type. If there is no activity for a certain product type put a zero in that box. Total and subtotal where required.

TAX VALUE

TAX VALUE OF

TAX VALUE

TOTAL

TAX VALUE

OF CHEWING

SMOKING TOB.

TAX VALUE

OF LITTLE

TAX VALUE (ADD

OF SNUFF

TOBACCO

OTHER THAN

OF R-Y-O

OF CIGARS

CIGARS

COL.

R-Y-O

A THRU F)

(Tax Values Must Be Shown for Each Product Type)

1 Tax Value of All Products Sold in Alabama (Gross sales less

credit returns). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

LESS NONTAXABLE SALES:

2 Sales to National Guard Units . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Sales to United States Government. . . . . . . . . . . . . . . . . . . . . . .

4 Sales to Federally Recognized Indian Reservations . . . . . . . . . .

5 Total Nontaxable Sales

(Add lines 2 through 4 of each column) . . . . . . . . . . . . . . . . . . . .

6 GROSS TAX DUE (Line 1 minus line 5 of each column)

Was any of the product shown in Column D roll-your-own

tobacco made by a *NPM?

Yes

No If yes,

complete Schedule D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 Less Credits (Attach letter from Department)

Caution: Credit taken cannot exceed gross tax due . . . . . . . . . .

8 Net Tax Value Due (Line 6 minus line 7 of each column). . . . . .

9 Failure To Timely File Return Penalty (The greater of 10% of column G, line 8 or $50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10 Failure To Timely Pay Tax Penalty (10% of column G, line 8). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 Interest (Contact the Department for rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12 AMOUNT DUE (Add column G, lines 8 through 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Check here if amount remitted through

Electronic Funds Transfer (EFT) . . . . . . . . . . .

Under penalties of perjury, I hereby certify that the return made by me is true and correct.

SIGNATURE

TITLE

DATE

*Manufacturer not participating in the Tobacco Master Settlement Agreement.

This tax return and the proper remittance must be filed with the Alabama Department of Revenue between the first and the twentieth of each month for ALL tobacco products other than

cigarettes sold and delivered into Alabama during the preceding month. Even if there is no activity during the month, a tax return must be filed and marked “NO ACTIVITY.” The original tax return

and remittance must be submitted to the Alabama Department of Revenue at the address above. Retain a copy of the tax return and supporting documents in your files subject to audit and

inspection by the Alabama Department of Revenue.

Any wholesaler who refuses or fails to file the return and make the proper remittance within the time allowed may subject their stamping permit to possible revocation (Sections 40-25-16 and 40-

2A-8, Code of Alabama 1975).

Make remittance (check, money order, etc.) payable to the Alabama Department of Revenue. A separate check must be remitted for state and county tobacco tax payments. Cash sent

through the mail is sent at the taxpayer’s risk. Tax payments equaling $750 or more in a given month obligate the taxpayer to remit taxes by Electronic Funds Transfer (EFT). You may

choose to make payment by EFT if the amount is less than $750.

SEE BACK FOR TAX RATES