Form 73a420 - Monthly Report Of Cigarette Wholesaler

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73A420 (2-12)
FOR DEPARTMENT USE ONLY
MONTHLY REPORT OF
Commonwealth of Kentucky
CIGARETTE WHOLESALER
DEPARTMENT OF REVENUE
1 2
__ __ __ __ __ __ / __ __ / __ __ / __ __
Account Number
Tax
Mo.
Yr.
Name and Address of Wholesaler
Month of ____________________________________
License Number ______________________________
INSTRUCTIONS:  Complete all items for your residency status, since failure to do so renders this report unacceptable (residents complete all columns, nonresidents complete Unstamped
Packages column and column (a)).   Note requested information and certification on page 3 of this form.   Attach remittance for the Cigarette Enforcement and Administration Fee
computed due on line 15.  Make check payable to Kentucky State Treasurer.
➤IMPORTANT: This report shall include cigarettes in one size package. Different
STAMPED PACKAGES
size packages require separate reports. Check applicable block for this report.
Other States
Total of
Packages of cigarettes referred to in Section I must be of uniform size insofar as
UNSTAMPED
Kentucky
(enter name(s) below)
Stamped Packages
quantity of cigarettes per package is concerned.
PACKAGES
(d)
(a)
(b)
(c)
Packages of:  20’s
 25’s  Other ____________
(a) + (b) + (c)
SECTION I—Packages of Cigarettes
Summary of Transactions
  1.  Balance on hand first day of month .........................................................................................
2. Total received during month (complete Schedule A) ...............................................................
+
+
+
+
+
3. Total (add lines 1 and 2) ..........................................................................................................
=
=
=
=
=
4. Total stamped during month ....................................................................................................
+
+
+
+
5. Balance in columns .................................................................................................................
=
=
=
=
=
6. Net packages sold (if tax-exempt, enter in Unstamped Packages) (complete Schedule C) ...
7. Packages returned to manufacturer ........................................................................................
8. Balance on hand (line 5 minus lines 6 and 7) .........................................................................
=
=
=
=
=
8a. Actual inventory as of ______________________ (explain any difference between 8 and 8a) ➤
SECTION II—Stamp Reconciliation
  9.  Balance on hand first day of month .............................................................................................................................
10. Total purchased during month .....................................................................................................................................
+
+
+
+
11. Total (add lines 9 and 10) ............................................................................................................................................
=
=
=
=
12.  Total affixed during month (must agree with line 4) .....................................................................................................
13. Balance on hand (line 11 minus line 12) .....................................................................................................................
=
=
=
=
13a. Actual inventory as of _____________________ (explain any difference between 13 and 13a) ➤
SECTION III—Cigarette Enforcement and Administration Fee
14.  Total stamps affixed during month (must agree with lines 4 and 12) ..........................................................................
15. Total fee due (line 14 of column(b) multiplied by $0.003) .....................................................................................
$
AMOUNT DUE
Attach check payable to Kentucky State Treasurer to this return and mail to Kentucky Department of Revenue, Frankfort,
➤ Complete each page and sign on page 3.
Kentucky 40620 by the 20th day of the month following the month in which the cigarette transactions occurred.

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