Looking for a Arkansas Department Of Finance And Administration Forms And Templates? Download it for free!

Tobacco Product Self-Assessment Excise Tax Report Form - Arkansas Department Of Finance And Administration

REVENUE DIVISION

STATE OF ARKANSAS

Office of Excise Tax Administration

Department of Finance

Miscellaneous Tax Section

and Administration

Post Office Box 896

1816 West Seventh Street, Room 2340

Little Rock, Arkansas 72203

Phone: (501) 682-7187

Fax: (501) 682-1103

TOBACCO PRODUCT SELF-ASSESSMENT EXCISE TAX REPORT

Name:______________________________________________ File #:____________________

Address:______________________________________________________________________

(Street)

(City)

(State)

(Zip)

Per Act 817 of 2007, it is unlawful for any person to receive or have in his/her possession for sale,

consumption, or any other purpose, any untaxed tobacco products or unstamped cigarettes unless the

tax prescribed by this Act has been paid directly to the Director by the person in possession of the

untaxed tobacco products or unstamped cigarettes.

Note: Examples of tobacco products (cigarettes excluded) are cigars, smokeless tobacco, chewing

tobacco, pipe tobacco, etc….

7/31/07 through 2/28/2009

The delivered cost of untaxed tobacco products purchased: $____________

Multiply the delivered cost by 32%:

X 32%

Tobacco Product Tax due

$____________

3/01/2009 through current

The delivered cost of untaxed tobacco products purchased: $ ____________

Multiply the delivered cost by 68%:

X 68%

Tobacco Product Tax due

$____________

Total Tobacco Product Tax due (Class Code 5311)

$____________

This completed form and related payment are to be mailed to the Miscellaneous Tax Section address

reflected at the top of this form.

----------------------------------------------------------------------------------------------------------------------------------

I hereby affirm that I have reviewed my purchases of untaxed cigarette products since 7/31/07 and the

above information is true and correct to the best of my knowledge.

Signature:___________________________________________ SS#: ________________________

Telephone number:____________________________________ Date:________________________

Tobacco Product Self-Assessment Excise Tax Report Form - Arkansas Department Of Finance And Administration

Related Articles

Related forms

Related Categories