Wisconsin Distributor'S Tobacco Products Tax Return Form - State Of Wisconsin

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WISCONSIN DISTRIBUTOR’S TOBACCO PRODUCTS TAX RETURN – Out-of-State Permittees
IMPORTANT! Please read the instructions sheet (form TT-105a) before completing this form.
TT-105: Page
of
Name, Address & Wis. Permit Number
Month & Year
For assistance & forms:
Mail your return with check payable to:
(please complete or correct)
Call (608) 266-8970
Wisconsin Department of Revenue
FAX (608) 261-7049
Box 93640
Federal Employer ID No.
E-mail: excise@dor.state.wi.us
Milwaukee WI 53293-0640
For EFT info. call (608) 264-9918
Permit Cancellation:
Permits are not transferable and must be returned to the department for
Cancel my permit effective
cancellation. Attach your permit to your final return.
SCHEDULE 1 - TAXABLE SALES SCHEDULE
ROLL-YOUR-OWN (RYO) TOBACCO PRODUCTS:
Instructions: Enter all tobacco products sold to persons in Wisconsin who do not hold a tobacco products dis-
(See TT-105a for defintion of “roll-your-own”.)
tributor permit (TPD) with our department. Include all samples, “free” products and promotional products.
Do not include nontobacco items (e.g. papers, pipes, lighters) or cigarettes.
*Manufacturer’s List Price is the manufacturer’s established list price to distributors prior to any reductions for
Submit in duplicate when columns A, B, C & D completed.
volume or discount.
Tobacco Products
Column A
Column C
Column D
Column B
Invoice
City
Sold To
(including RYO) @
Total Ounces
Line
Number
Date
*Manufacturer’s List Price
Purchased From
Brand Name
Manufacturer
(per brand)
1
Balance Brought Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
Balance brought forward . . . . . . . . . . . .
2
3
4
5
6
7
8
9
10
11
12
13
Total Taxable Sales – Add lines 1 through 13 (only complete line 14 on last page
Page Total:
14
$
of schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Dept. Use Only ➔
TAX DUE – Multiply total taxable sales on
Grand Total:
$
15
PAY THIS AMOUNT
line 14 by tax rate of 25%.
(Last page only)
Check this box if you are paying the tax due by electronic funds transfer (EFT).
I declare under penalties of law that I have examined this return and all attachments and to the best of my knowledge and belief, it is true, correct and complete.
Signature of Permittee (or authorized agent)
Preparer’s Name (print or type)
Preparer’s Phone Number
Date
(
)
TT-105 (R. 5-04)
Wisconsin Department of Revenue

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