Form Cig-57 - Ohio Cigarette Consumer'S Use Tax - Ohio Department Of Taxation printable pdf download

CIG-57

Rev. 6/05

•

P.O. Box 530

Columbus, OH 43216-0530

Ohio Cigarette Consumer’s Use Tax

Reporting Period

Ohio Revised Code Section 5743.32 provides that

every person who has acquired cigarettes for use,

storage or other consumption in this state shall, on

For the month of

, 20

or before the 15th day of the month following receipt

of such cigarettes, make and file with the tax com-

Name

missioner a return showing the amount of cigarettes

acquired, together with remittance of the tax thereon;

Address

provided that the tax levied in ORC Section 5743.02

and 5743.024 has not been paid.

City

State

ZIP

Instructions

Line 1 – This line should include cigarettes (sticks) shipped into all areas of Ohio except Cuyahoga County reported on the

schedule (see reverse side for a the schedule to be completed and for a listing of municipalities in Cuyahoga

County). All lines on the return must be completed.

Line 2 – This is the Ohio tax rate.

Line 3 – Multiply line 1 by line 2. This is the tax due on the cigarettes (sticks) shown on line 1. (Ex. 1 carton = 200 sticks.)

Line 4 – This line should include cigarettes (sticks) shipped into Cuyahoga County.

Line 5 – This is the combined Ohio/Cuyahoga County tax rate.

Line 6 – Multiply line 4 by line 5. This is the tax due on the cigarettes (sticks) shown on line 4. (Ex. 1 carton = 200 sticks.)

Line 7 – Add lines 3 and 6. This amount is the total tax due. Make your check payable to the Ohio Treasurer of State.

1. Total number of cigarettes (sticks) shipped into Ohio during report period

.0625

2. Tax rate ..................................................................................................

3. Tax liability (line 1 x line 2) ....................................................................................................... $

4. Total number of cigarettes (sticks) shipped into Cuyahoga County .........

.06475

5. Tax rate ..................................................................................................

6. Tax liability (line 4 x line 5) ....................................................................................................... $

7. Total due with this report (add lines 3 and 6) ............................................................................ $

I declare under penalties of perjury that this return (in-

cluding any accompanying schedules and statements)

Signature

has been examined by me and, to the best of my knowl-

edge and belief, is a true, correct and complete return

and report.

Title

Date

Mail report and check or money order covering tax due to the

Excise Tax Unit, P.O. Box 530, Columbus, OH 43216-0530.

Form Cig-57 - Ohio Cigarette Consumer'S Use Tax - Ohio Department Of Taxation

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