Form Tp-101 - Tobacco Products Tax Form
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1
2MONTANA
State of Montana
TP-101
Rev. 11-00
Department of Revenue
Tobacco Products Tax
(Title 16, Chapter 10, MCA)
___________
Date
_____________________________________________________________________
Name of Remitter
___________________________________________________________________________
Address
__________________________________
______________
_________________
City
State
Zip Code
Shipments and/or purchases of tobacco products (other than cigarettes) for month of _______________________, 20_____
1. Number of invoices attached ............................................................................................. ____________________
2. Gross amount of Montana invoices ...................................................................................
____________________
3. Twelve and one-half percent (12 1/2%) of line 2 .................................................................. ____________________
4. Less 5% discount ..........................................................................................................
____________________
5. Balance .........................................................................................................................
____________________
6. Less credits from form TP-102 ......................................................................................... ____________________
7. Adjustments ..................................................................................................................
____________________
8. Total amount remitted .....................................................................................................
____________________
I hereby swear or affirm under penalty or perjury that the statements contained herein are true and correct to the best
of my knowledge.
_______________________________
Signature of Principal or Agent
_______________________________
Telephone
Instruction for Form Preparation
1. Prepare in duplicate. Submit original to Montana Department of Revenue, Registration and Licensing, P.O. Box 1712,
Helena, MT 59604-1712, with remittance. Retain duplicate in company files for field audit purposes.
2. Submit with copies of invoices attached for all tobacco products, supporting unit costs from the manufacturer.
3. This form must be delivered to the Department of Revenue by the tenth day of each month covering products shipped
during the preceding month, and/or products shipped during the preceeding month in Montana.
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