Ets Form 140 - Cigarette Wholesaler'S Monthly Report - 2003
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1
2Wyoming Department of Revenue
122 West 25th Street (Herschler Building), Cheyenne, Wyoming 82002-0110
ETS Form 140 Revised 07/01/03
Cigarette Wholesaler's Monthly Report
SSN/EIN _______________ Report for Month Ended
License Number
Company Name
Mailing Address
Business Location
City
State
ZIP Code
(20)
Packages (25)
Other
Total
Cigarette Inventory Reconciliation (Packages):
1.
Beginning inventory
2.
Purchases
3.
Cigarette packs available for sale
4.
Deductions:
a. Exported from state
b. Sold on Wind River Reservation - Exempt (See Instructions)
c. Ending inventory - without Wyoming stamps
d. Ending inventory - stamped with Wyoming stamps
5.
Total Deductions
6.
Stamped packages sold/delivered
Stamp Settings Reconciliation:
Stamps
Settings
Total
7.
Beginning stamp inventory
8.
Stamps purchased during the month
9.
Total stamps available
10.
Deductions:
a. Stamps spoiled and returned to Department for credit
b. Unaccountable stamps
c. Ending inventory - stamp readings
d. Ending inventory - stamped packages
11.
Total Deductions
12.
Total stamped packs sold/delivered during the month
Taxable Cigarette Sales:
Packages
(20)
Packages (25)
Other
Size
Purchaser
Purchaser's Location
(1)
See Attached Wholesaler's Printout
(2)
(3)
Totals for This Page
Total Number of Packages of
Totals for Page 2
ALL Sizes Sold During the
Month
Grand Total
Under penalty of law, I declare that I have examined this report, including accompanying schedules and statements and, to the best of my
knowledge and belief, it is correct and complete.
Signed:
Title:
Printed Name:
Telephone No:
Date: ________________
Calculation of Cigarette Taxes Due:
1.
Enter the Grand Total of 25-Cigarette Packages Sold During the Month
2.
Multiplication Factor (14.10 cents per package)
0.1410
3.
Tax Due on 25-Cigarette Packages
This report is due on or before the 20th day of the month following the tax period indicated above.
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