Tax Declaration For Cigarettes Form - State Of Maine
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1STATE OF MAINE
TAX DECLARATION FOR CIGARETTES
Under Maine law, consumers are required to pay Maine taxes on cigarettes possessed in Maine. When you buy from a retailer
in Maine, the taxes have been paid (see the Maine tax stamps on the bottom of each pack). When you purchase in any month
more than two cartons of cigarettes that do not bear a Maine cigarette tax stamp, the cigarette and use taxes must be declared
.
and paid on all of the cigarettes possessed. TAX IS DUE ON ALL CIGARETTES IMPORTED INTO THIS STATE
_______________________ ___
___________________ ___________________
______________________
Last name
First name
MI
Social Security Number
Telephone Number
___________________________________________ ____________________________
_______ ____________________
Street Address
City
State
Zip code
Please list your purchases here and calculate the tax due below.
Invoice
Seller
# Cartons
# Packs/carton
Amount Paid
Date
Belinda Guyon
Maine Revenue Services
PO Box 9101
Augusta, ME 043329101
(207) 6249741
Cigarette Tax
1
Cigarettes purchased before September 19, 2005
a
Packs of 20: Number of packs _______ X $1.00 =
Packs of 25: Number of packs _______ X $1.25 =
b
Cigarettes purchased after September 18, 2005
Packs of 20: Number of packs _______ X $2.00 =
c
d
Packs of 25: Number of packs _______ X $2.50 =
2
Amount paid for Cigarettes
3
Total (add lines 1a, 1b, 1c, 1d and 2)
4
Use Tax Rate
5%
5
Use Tax Owed (multiply line 3 by line 4)
6
Total Tax Owed (add lines 1a, 1b, 1c, 1d and 5)
Note: Maine Revenue Services is actively enforcing reporting requirements for internet cigarette retailers. If this declaration
is for cigarettes purchased over the internet, complete the purchase information on the reverse of this form. Please mail this
completed form along with your check or money order to: Belinda Guyon, Maine Revenue Services, PO Box 9101,
Augusta, ME 043329101
Under penalties of perjury, I declare that I have examined this return and, to the best of my knowledge and belief, it is true,
correct and complete.
Signature: _______________________________________
Date _____________________________
Make a copy for your records and enter your social security number on your check with the words “cigarette taxes”.
If you have questions or need assistance, please call Maine Revenue Services at (207) 6249741.
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