Form Com/attd-901 Cigarette Floor Tax Return Distributors, Wholesalers, And Retailers

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S
N
J
TATE
EW
ERSEY
OF
D
T
EPARTMENT OF THE
REASURY
D
T
IVISION OF
AXATION
PO BOX 187
T
, NJ
RENTON
08695-0187
CIGARETTE FLOOR TAX RETURN
DISTRIBUTORS, WHOLESALERS, AND RETAILERS
DUE DATE: September 1, 2004
Federal Identification
License No.
INSTRUCTIONS
Check One Category:
Distributor – Complete lines 1 through 4 and 5
Wholesaler – Complete lines 1 through 2 and line 5
Retailer – Complete lines 1 through 2 and line 5
1.
Conduct an inventory of all cigarettes and tax stamps on hand as of the start of business on July 1, 2004. Prepare the return in
duplicate. Retain the second copy for your records and inspection by a representative of the Division of Taxation. The tax is
due on all stamped product and any stamps in inventory.
2.
For each package size, multiply the quantity on hand by the additional tax due. For Distributors, also calculate the additional tax
due on all unaffixed tax stamps. Enter the result in the “Tax Due” column. Total lines 1 through 4 and enter sum on line 5.
3.
Make your check or money order payable to the “Cigarette Floor Tax”. Mail your payment with this tax return by September 1,
2004 to the New Jersey Division of Revenue, PO Box 250, Trenton, N.J. 08646-0250, in the envelope provided. You may
obtain information on completing this form by contacting (609) 984-7554.
4.
If your name and address is incorrect, check the “Name/Address Correction” box below and make any corrections.
NOTE: There will be NO CONSOLIDATED RETURNS filed for this tax increase. Each licensee must file a separate return for
each licensed location. One check may be used to pay the additional tax due for multiple locations, but the returns for
which the check has been issued must accompany the payment.
(A)
(B)
(C)
(D)
Taxable Inventory
Quantity on Hand
Increase in Tax Rate
Tax Due
B x C = D
1.
Cigarettes Stamped (20 per pack)
$
.35
$
2.
Cigarettes Stamped (25 per pack)
$
.4375
$
3.
Unaffixed Stamps (20 per pack)
$
.35
$
4.
Unaffixed Stamps (25 per pack)
$
.4375
$
5.
Total Tax Due (Lines 1 – 4)
$
st
st
ALSO NOTE: Cigarettes held on July 1
, for which the additional tax has not been remitted by September 1
, will be
considered contraband and subject to confiscation.
I do solemnly declare and affirm under penalties of perjury that the contents of the foregoing document are true and correct to the best
of my knowledge, information and belief.
Print Name
Business Phone Number
Signature
Title
Date
Change of name/address:
Name:
______________________________________________________________________________________________
Trade Name: ______________________________________________________________________________________________
Street, City, State Zip: ______________________________________________________________________________________
COM/ATTD-901 Rev. 6/04

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