Form 8a - Colorado Cigarette Tax Return

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DR 0221 (05/01)
8A
COLORADO DEPT OF REVENUE
COLORADO CIGARETTE
1375 SHERMAN ST
DENVER CO 80261-0013
TAX RETURN
(303) 205-8211
EXT. 6860
Are you paying your taxes by EFT?
Yes
No
DO NOT WRITE IN THIS SPACE
Show change of ownership,
name and/or address here.
USE ACCOUNT NUMBER
LIABILITY INFORMATION
PERIOD COVERED
DUE DATE
for all reference
county
city
industry
type liability date act
month
year
month
day
year
FEIN
SS Number 1
SS Number 2
If Federal Employers Identification Number (FEIN) is pre-printed in the above space, please check your records to see if you have the same number.
If you have a different number, correct the one above so that it corresponds with your records. If no number appears in the above space, please fill
0800-100
in with the FEIN you have on your records.
Gross Amount
Discount
Net Due
IMPORTANT: Failure to comply with the reporting and other requirements
Column A
Column B
Column C
of Title 39, Session Laws of Colorado, is a violation subjecting the violator
to the penalties prescribed.
1. 20 Count Stamp Sheet Purchases (Schedule Type 121 Totals)
2. 20 Count Stamp Roll Purchases (Schedule Type 122 Totals)
3. 20 Count Wide Stamp Sheet Purchases (Schedule Type 126 Totals)
4. 25 Count Stamp 10 Across Purchases (Schedule Type 123 Totals)
5. 25 Count Stamp 12 Across Purchases (Schedule Type 124 Totals)
6. 30 Count Stamp Sheet Purchases (Schedule Type 125 Totals)
7. 20 Count Stamp Meter Purchases (Meter Schedule Type 120)
(145)
8. Total purchases
(200)
9.
Late filing penalty: A. 10% of line 8, column A
(140)
B. Disallowed discount, line 8, column B
(300)
10. Late filing interest:
PER MONTH
11. Total of tax, penalty and interest (add lines 8, 9A, 9B and 10)
(905)
12. Credit for returned stamps (original manufacturer's statement or
affidavit of returned merchandise must be attached.)
(900)
Discount taken on returned stamps (4% of line 12)
13.
Net credit (line 12 minus line 13)
14.
(410)
15. Amount of tax credit to be refunded this period (only if line 14 exceeds line 11)
S
(355)
16. Total Remittance Due (line 11 less line 14) (If filing by EFT put zero in this box)
I hereby certify, under penalty in the second degree, that the statements made herein are, to the best of my
knowledge, true and correct.
Date
Name of Business or Taxpayer
Agent or Officer
Title
Please photocopy and retain copy for your records.

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