Form Ct-Txchg - Cigarette Inventory Floor Tax April 2004
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1
2MONTANA
CT-TXCHG
Rev 4-03
Cigarette Inventory Floor Tax
All Wholesalers, Subjobbers, Retailers, and Vendors must file this form whether or not a floor
tax liability is due and owing
Business Name
License No.
Date
Principal or Agent Name
Phone
Address
Fax
City
State
Zip
Instruction for form preparation
1.
Prepare in duplicate. Submit original to Montana Department of Revenue, Customer Intake Process, P.O. Box 1712, Helena, MT
59604-1712, with payment. Retain duplicate in company file for possible field audit purposes.
th
2.
This return is based on your cigarette inventory as of 12:01am on April 30
, 2003 less your inventory balance at the end of your
most recently concluded income tax reporting year.
3.
The report must be signed, and returned, with your tax payment, to the Department of Revenue, by no later than June 30, 2003.
4.
Any cigarette dealers and operators failing to file the report and/or pay the tax may be assessed penalties and interest.
Section 1 – Cigarette vending machine owner
Check here if your cigarettes are serviced and stocked by a vendor. Your vendor is then responsible for reporting and paying
the tax increase. Enter your vendor information below, sign and return this form to the department on or before 6/30/2003
____________________________________________________________________________________________________
Vendor name
Address
Phone
Check here if you service and stock your own machine. Detail the various machine locations in section 3, and complete
section 2 below.
Section 2 – Cigarette and tobacco product tax reconciliation
1. Total Cigarette tax due (total column E, section 3) .................................................. $ ____________________
2. Late file penalty, if post marked after 6/30/03
($50 or the amount of tax due on line 1, whichever is less) ..................................... $ ____________________
3. Late pay penalty, if post marked after 6/30/03
(1.5% per month or fraction of month on the unpaid tax,
not to exceed 18% of line 1) .................................................................................... $ ____________________
4. Interest, if post marked after 6/30/03
(12% per year accrued at 1% a month or fraction of a month) ............................... $ ____________________
5. Total due (total line 1, 2, 3 and 4)............................................................................. $ ____________________
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
Page 1
344
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