Form 55a - Nebraska Manufactured & Imported Cigarette Report July 2007

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Nebraska Manufactured & Imported Cigarette Report
FORM
55A
• A copy or information from this report will be given to the Attorney General’s Office
• Cigarette is defined to include roll-your-own tobacco
Name as Shown on Form 55 or Form 56
PLEASE DO NOT WRITE IN THIS SPACE
Nebraska Identification Number
Tax Period
Due Date
RESET FORM
• You may attach a computer printout in place of filling out the form below, but all of the same information must be supplied.
• If you attach a computer printout, you must still complete the reverse side of this report.
• Column C — Convert packs and cartons to individual cigarettes.
• Column D — Report the number of ounces of roll-your-own (RYO) tobacco sold in Nebraska. Divide ounces by .09 to convert to
number of equivalent cigarettes.
Column C
Column D
Column A
Column B
Total Number of Ounces of
Total Number of Individual
Name of Supplier From Whom
Brand Family Name of Cigarettes
RYO Tobacco Sold in Nebraska
Cigarettes Stamped and Sold in
You Purchased the Cigarettes
or RYO Tobacco
Nebraska for Each Brand
Ounces
Ounces
Equivalent Cigarettes
Equivalent Cigarettes
or RYO Tobacco
(You must complete the reverse side)
7-2007
5-216-1999 Rev.
Supersedes 5-216-1999 Rev. 10-2004

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