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Montana Form Tp-102 - Pre-Paid Tobacco Product Tax Credit - Montana Department Of Revenue

MONTANA

TP-102

Rev 7-05

Pre-Paid Tobacco Product Tax Credit

Business Name

License No.

Date

Principal or Agent Name

Phone

Address

Fax

City

State

Zip

Instruction for form preparation

1. Prepare in duplicate. Submit the original to Montana Department of Revenue, Customer Intake Process, P.O. Box

1712, Helena, MT 59604-1712. Retain a duplicate in company file for field audit purposes.

2. Credit claimed on schedule B for tobacco products tax pre-paid from previously submitted TP-101 reports must be

substantiated with copies of the reported TP-101, and detailed inventory notes.

Section 1 –Tobacco product tax credit reconciliation

1. Total pre-paid tobacco products tax

(total line 3, column A, schedule A) ............................................................ $ ___________________

2. Total Pre-paid moist snuff products tax

(total line 3, column B, schedule A) ........................................................... $ ___________________

3. Total add line 1 and line 2 .......................................................................... $ ___________________

4. Discount rate................................................................................................

0.015 (1.5%)

5. Total tobacco product tax discount (multiply line 3 by line 4) ..................... $ ___________________

6. Tobacco product tax credit (subtract line 5 from line 3) .............................. $ ___________________

I hereby swear and affirm under penalty of false swearing that the information herein and attachments are true

and correct to the best of my knowledge.

Print Name of Principal or Agent

Date

Signature of Principal or Agent

318

Montana Form Tp-102 - Pre-Paid Tobacco Product Tax Credit - Montana Department Of Revenue