Form Tt-104 - Tobacco Products Use Tax Return - State Of Wisconsin
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WISCONSIN TOBACCO PRODUCTS USE TAX RETURN
Make your check payable and mail to:
Due Date:
Wisconsin Department of Revenue
This return is due on or before the 15th day of the
Mail Stop 5-107
following month in which you acquire for use tobacco
PO Box 8900
products from a source outside Wisconsin on which
Madison WI 53708-8900
the Wisconsin tobacco products tax has not been paid.
(608) 266-8970
PLEASE PRINT OR TYPE
2. Federal Employer ID No. AND
Social Security No. (if you are
1. Name of Individual, Partnership or Corporation
(FEIN)
an individual or sole proprietor)
Wisconsin County of Business Location (or home if individual and
3. Business Name (if applicable)
not a business)
4. Mailing Address - Street or P.O. Box
City
State
Zip Code
5. Type of Organization (check one)
Indicate Date Incorporated
Other, describe below:
Wisconsin corporation
Individual
Partnership
Out-of-state corporation
COMPUTATION OF THE WISCONSIN TAX DUE ON UNTAXED TOBACCO PRODUCTS
Pursuant to Section 139.78 of the Wisconsin Statutes, every person who acquires tobacco products for use in Wisconsin upon which
the Wisconsin tobacco products excise tax has not been paid must report the untaxed tobacco products to the department and pay the tax
due. The return and tax are due within 15 days after the month in which the tobacco products are acquired. When the tax due is not timely
paid, it becomes delinquent and subject to a penalty of 5% of the tax for each 30 days or fraction thereof that the tax is not paid up to a
maximum of 25% but not less than $10. In addition, interest on the delinquent tax accrues at the rate of 1.5% per month from the date the
tax is due until paid.
Tobacco products include cigars, cheroots, granulated plug cuts, snuff, chewing tobacco, clippings, and other forms of tobacco pre-
pared in such a manner as to be suitable for chewing or smoking in a pipe or otherwise (includes tobacco that can be used for “roll your
own” cigarettes). Tobacco products do not include manufactured cigarettes or nontobacco items like papers, pipes or lighters.
Use the schedule below to compute the tobacco products use tax you owe. Enter your purchase(s) on the lines below and provide
all the information requested. Then total your purchases on line 13, and multiply by the tax rate shown on line 14 to compute the tobacco
products use tax you owe. You can attach a schedule itemizing your untaxed purchases if additional space is needed.
Col. 3
Col. 4
Col. 1
Col. 2
Col. 5
Line
Date
Invoice
Purchased From
Amount Paid
Name
City & State
No.
Received
Number
(your cost)
Brand Name
6.
7.
8.
9.
10.
11.
12.
13.
TOTAL COST OF YOUR PURCHASES (add lines 6 through 12 in column 5)
x .25
14.
TOBACCO PRODUCTS TAX RATE (25% of cost)
TOBACCO PRODUCTS USE TAX DUE (multiply line 13, column 5, by 25%). PAY WITH THIS RETURN ➙
15.
$
I declare under penalties of law that the above information is true, correct and complete to the best of my knowledge and belief.
Date
Your Telephone Number
Your Signature
(
)
TT-104 (R. 5-04)
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