Form 70-022 - Iowa Tobacco Products Monthly Tax Return In State Distributors - Iowa Department Of Revenue
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1
2Iowa Tobacco Products Monthly Tax Return
Iowa Department of Revenue
In-State Distributors
RETURN FOR MONTH OF ________________________ YEAR ______________
FOR OFFICE USE ONLY
DUE DATE: On or before the 20th day of the month following the
Postmark Date:
_________________
month for which the return covers.
Audit Period: _____________________
LICENSE NO: __________________________________
MAIL THIS FORM TO:
Tobacco returns
Iowa Department of Revenue
NAME: _____________________________________
and all supporting
PO Box 10456
documentation are
Des Moines, Iowa 50306-0456
ADDRESS: _____________________________________
required to be
OR FAX IT TO: 515/281-3756
maintained for five
_____________________________________
FOR ASSISTANCE, CALL: 515/281-8023
years.
_____________________________________
Only approved brands of roll-your-own product may be
sold in Iowa. Any product not on the list is contraband.
Do not include cigarettes and little cigars which
Go to /business/CigTobIndex.html
are subject to the Iowa cigarette tax.
Line
Invoice
From Whom Purchased
Mfg’s Gross
Date Rec’d
No.
Date
Number
Name
City, State
List Price
Into Stock
1
$
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Total. Add lines 1-16.
$
18
Back Page Total from line 40, if applicable
$
19
Total. Add lines 17 and 18.
$
20
Credits from Schedule I (destroyed)
21
Credits from Schedule II (returned to manufacturer)
22
Credits from Schedule III (sold out of state)
23
Total Credits. Add lines 20 - 22.
$
24
Total Manufacturer’s Gross List Price Less Credits. Line 19 minus line 23.
$
25
TAX RATE: 22% of amount on line 24
$
26
Less 3-1/2% DISCOUNT of amount on line 25
$
27
Overpayment Credit. An overpayment letter must be attached.
$
28
Penalty, if applicable
$
29
Interest, if applicable
$
30
TOTAL AMOUNT DUE: Make check payable to TREASURER - STATE OF IOWA
$
I declare that I have examined this return and to the best of my knowledge and belief, it is a true, correct and complete return.
Authorized Signature: ______________________________________________ Telephone Number: _________________________
Title of Officer: ___________________________________________________ Date: ___________________
70-022a (5/19/04)
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