Other Tobacco Products Excise Tax Return Form
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3NEVADA DEPARTMENT OF TAXATION
1550 East College Parkway, Room #115
Carson City, Nevada 89706
(775) 687-6483
Other Tobacco Products Excise Tax Return
I hereby certify that this return, including any accompanying schedules and statements, has been examined by me and to
the best of my knowledge and belief is true, correct and a complete return.
OTP Number
Authorized Signature
Title
Wholesale Dealer
Wholesale Dealer Address
Report Prepared By
Title
Telephone Number
Fax Number
Month reporting
Due on or before the 20th of the following month
PLEASE NOTE:
1. The following documentation must accompany this report pursuant to NRS 370.465:
A. A list of all Tobacco Product purchases, other than cigarettes.
B. A copy of the invoice for each purchase made directly from the manufacturer or from a wholesale
dealer not licensed in Nevada.
2. This report is due even if no purchases were made for the month (NAC 370.160).
3. No credits will be allowed without proper documentation.
for office use only
1. *Total wholesale price of products purchased
or produced.
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2. Credit for sales to out of state customers.
(form otp 02 and copies of sales invoices must be attached)
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3. Credit for sales to Tribal customers and/or U.S.Military.
(form otp 02 and copies of sales invoices must be attached)
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4. Credit for returned merchandise.
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(form and copy of mfg credit memo must be attached)
5. Total purchases subject to excise tax.
(line 1 minus line 2, minus line 3, minus line 4)
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6. Tax (30% of line 5).
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7. Collection allowance (2% of line 6).
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8. Tax due (line 6 minus line 7).
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9. Penalty (10% of line 8).
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10. Interest (1% of line 8 for each month or fraction thereof).
( interest is 1.5% per month prior July 1, 1999 for excise
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tax due, in addition of the 1% per month after July 1, 1999)
11. Total due (line 8, plus line 9, plus line 10).
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(Make check payable to the Nevada Department of Taxation)
FOR OFFICE USE ONLY
BY
DATE REC.
CK#
AMOUNT
POST MARK
PENALTY
INTEREST
*Wholesale price means the established price for which a manufacturer sells a product made from tobacco, other
than cigarettes, to a wholesale dealer, before any discount or other reduction is made.
OTP 01
Revised 7/29/99
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