Form Otp 01 - Other Tobacco Products (Otp) Excise Tax Return Page 4
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4OTHER TOBACCO PRODUCTS (OTP) FORM 4
USE ADDITIONAL SHEETS IF NECESSARY
OTP License No.
Return for month ending___________________
Wholesale Dealer
Mailing Address
SALES OF OTHER TOBACCO PRODUCTS THAT TAX WAS PREVIOUSLY PAID AND REPORTED TO NEVADA
INVOICE DATE
INVOICE NO.
WHOLESALER PURCHASED FROM
MONTH/YEAR TAX WAS PAID
WHOLESALE PRICE
TOTAL WHOLESALE PRICE: $
Instructions:
1. Enter the invoice date, invoice number, name of wholesaler product was purchased from, date and year in which
the tax was paid and reported to Nevada and the wholesale purchase price of the product sold.
2. Total the Wholesale Price column and enter the the Total Wholesale Price of the products sold.
OTP 04
Revised 8-7-01
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