Form 800-D - Tobacco Products Tax Return Form
ADVERTISEMENT
1
2800-
FORM
D
T
P
T
R
OBACCO
RODUCTS
AX
ETURN
Cigarette Distributor's Monthly Return of Cigarettes Received
Please Check Appropriate Box :
Separate Return
Combined Return
Check box if AMENDED and enter correct MONTH/YEAR
(below) being "amended"
Name of Distributor
Reporting Period (Month)
OFFICE USE
(Due 15 days after end of month)
ONLY
Mailing Address
Business Location Address: (if different from above)
(Enter Whole Dollars)
Check here if mailing address has changed.
1. Total number of cigarettes received during the month . . . . . . . . . . . . . . . . . . . . . .
(from Schedule A)
2. Total Tax on Cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(total in Line 1 * $0.02)
3. Tax Paid with Form 145 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -
(Form 145 must have been timely filed)
4. Balance of Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
(Line 2 minus Line 3)
5. Interest(s) - if applicable. Calculate interest owed and enter amount . . . . . . . . . . +
(attach calculations)
6. Penalty(s) - if applicable. Calculate penalties owed and enter amount . . . . . . . . . +
(attach calculations)
7. TOTAL TAX DUE (Add Lines 4, 5, and 6). . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
under $10,000 make
over $10,000 must be wire transferred
For payments
Payments
check payable to the order of & mail to:
to the following account:
Office of the Navajo Tax Commission
The Navajo Nation
Check here if
Post Box 1903
Account Number: 4000901560
payment is made
Window Rock, Arizona 86515-1903
Wells Fargo Bank - Window Rock Branch
by wire transfer
Phone: (928) 871-6681
Window Rock, Arizona 86515
Amount
Fax: (928) 871-7608
Bank Routing Number: 091000019
$
I declare that the information contained in this document and any attachments thereto is true and correct to
the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations.
x
(
)
/
/
Taxpayer or Duly Authorized Agent Signature
Print or Type Name
Telephone Number
Date
ONTC
TOB - Form 800 - D
Revised: 2/12/2002
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial