Form 4426-20- Out-Of-State Missouri Cigarette Wholesaler Monthly Cigarette Tax Report - Missouri Department Of Revenue, Taxation Bureau

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MONTH OF
FORM
MISSOURI DEPARTMENT OF REVENUE, TAXATION BUREAU
P.O. BOX 811, JEFFERSON CITY, MO 65105-0811 (573) 751-7163
TDD 1-800-735-8966
4426-20
OUT-OF-STATE MISSOURI CIGARETTE WHOLESALER
LICENSE NUMBER
MONTHLY CIGARETTE TAX REPORT
(REV. 12-2007)
WHOLESALER NAME
ADDRESS
E-MAIL ADDRESS
CITY, STATE, ZIP
TELEPHONE NUMBER
FAX NUMBER
(___ ___ ___) ___ ___ ___ -___ ___ ___ ___
(__ __ __) __ __ __ -__ __ __ __
FOR 20s ONLY
(B) ST. LOUIS
(C) JACKSON
(D) TOTAL OF
(A) STATE ONLY
MISSOURI STAMPS
COUNTY ONLY
COUNTY ONLY
COLUMNS A + B + C
1. Missouri stamped cigarettes on hand first of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Missouri stamps unaffixed on hand first of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Missouri stamped cigarettes purchased from another licensed wholesaler
during month (Schedule B-1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Stamped cigarettes returned by customers during month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Missouri stamps purchased and received during the month (Form 304, Schedule C, Section 1)
6. Credit received in stamps during month (Form 304, Schedule C, Section 2) . . . . . . . . . . . . . . .
7. Subtotal (Lines 1, 2, 3, 4, 5, and 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. Stamped cigarettes returned to manufacturer (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
9. Missouri stamped cigarettes on hand end of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10. Missouri stamps unaffixed on hand end of month . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11. Total tax inventory used during month (Line 7 less Lines 8, 9 & 10) . . . . . . . . . . . . . . . . . . . . . .
12. *Stamped cigarettes sold into the State of Missouri (Attach Schedule F, F1 & F2) . . . . . . . . . .
*Line 11 should be the same as Line 12. If not, attach letter to report explaining the difference.
CALCULATION OF TAX DUE
CASH PURCHASES
CREDIT PURCHASES
WHOLESALERS ON A DEFERRED PAYMENT BASIS MUST FILE THIS REPORT WITH THE
TAXATION BUREAU AND PAY BALANCE DUE ON OR BEFORE THE FIFTEENTH (15TH)
13. Stamps purchased during the month (Line 5, Column D) . . . . . . . . .
DAY OF THE MONTH, COVERING ALL CIGARETTES AND TAX STAMPS RECEIVED DUR-
ING THE MONTH. WHOLESALERS ON A CASH BASIS MUST FILE REPORT ON OR
14. Tax Due — Line 13 multiplied by $.17 . . . . . . . . . . . . . . . . . . . . . . . .
BEFORE THE TWENTIETH (20TH) DAY OF THE MONTH.
15. Less: 3% of Line 14 (Discount is forfeited if not remitted on time). . .
NOTE: In the event that payment of the total deferment liability becomes delinquent after
16. Subtotal (Line 14 less Line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
fifteen (15) days from the first day of the month during which the purchases were made, the
17. Less payments previously made . . . . . . . . . . . . . . . . . . . . . . . . . . . .
director may discontinue credit privileges, revoke the license held by the wholesaler for a
period of one year, and notify the bonding company requesting that payment be made
18. AMOUNT DUE (Line 16 less Line 17) . . . . . . . . . . . . . . . . . . . . . . . .
under the terms of the bond.
19. Amount from Line 18 of Form 4426-25, Consolidated Monthly
Cigarette Tax Report (25s Only) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20. TOTAL AMOUNT DUE (add Lines 18 and 19) . . . . . . . . . . . . . . . . .
I do hereby certify under penalty of perjury that the foregoing and attached reports are a true and correct statement to the best of my knowledge and a complete and full presentation of all transactions from the best information available. If
you pay by check, you authorize the Department of Revenue to process the check electronically. Any check returned unpaid may be presented again electronically.
PRINT NAME
SIGNATURE
TITLE
DATE
__ __ / __ __ / __ __ __ __
MAKE CHECKS PAYABLE TO MISSOURI DEPARTMENT OF REVENUE AND MAIL TO TAXATION BUREAU, P.O. BOX 811, JEFFERSON CITY, MISSOURI 65105-0811. If you have questions or need assistance in completing this form,
please call (573) 751-7163 or email excise@dor.mo.gov. You may also obtain this form from the department’s web site at: TDD (800) 735-2966
MO 860-2593 (12-2007)
This publication is available upon request in alternative accessible format(s).

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