Form 8a - Colorado Cigarette Tax Return - Colorado Department Of Revenue
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1
2DR 0221 (06/30/05)
DEPARTMENT USE ONLY
8A
COLORADO DEPT OF REVENUE
COLORADO CIGARETTE
1375 SHERMAN ST
DENVER CO 80261-0003
TAX RETURN
(303) 205-8211 EXT. 6860
Are you paying your taxes by EFT?
Yes
No
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 in with the FEIN you have on
0800-100
your records.
Gross Amount
Discount
Net Due
IMPORTANT: Failure to comply with the reporting and other requirements of Title
Column A
Column B
Column C
39, Session Laws of Colorado, is a violation subjecting the violator to the penalties
prescribed.
1. 20 Count Stamp Sheet Purchases (Stamp Type 121 Totals)
2. 20 Count Stamp Roll Purchases (Stamp Type 122 Totals)
3. 20 Count Wide Stamp Sheet Purchases (Stamp Type 126 Totals)
4. 25 Count Stamp 10 Across Purchases (Stamp Type 123 Totals)
5. 25 Count Stamp 12 Across Purchases (Stamp Type 124 Totals)
(145)
6. Total purchases
(200)
Late filing penalty: A. 10% of line 6, column A
7.
(140)
B. Disallowed discount, line 6, column B
(300)
8.
Late filing interest:
PER MONTH
9.
Total of tax, penalty and interest (add lines 6, 7A, 7B and 8)
(905)
10.
Credit for returned stamps original manufacturer's statement or
affidavit of returned merchandise must be attached.
(900)
Discount taken on returned stamps (.9524% of line 10)
11.
12.
Net credit (line 10 minus line 11)
13.
If line 12 is more than line 9, subtract line 9 from line 12, this is your
(410)
overpayment (see instructions for how to apply for refund)
.
$
(355)
14.
If line 9 is more than line 12, subtract line 12 from line 9, this is the amount you owe (if filing by EFT put a zero in this box)
If your check is rejected due to insufficient or
I hereby certify, under penalty in the second degree, that the statements
uncollected funds the Department of Revenue may
collect the payment amount directly from your banking
made herein are, to the best of my knowledge, true and correct.
account electronically.
Agent or Officer
Title
Date
Name of Business or Taxpayer
Please photocopy and retain copy for your records.
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