Form 55a - Nebraska Manufactured & Imported Cigarette Report July 2007 Page 2
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1
2Column D
Column A
Column C
Column B
Total Number of Ounces of
Name of Supplier From Whom
Total Number of Individual
Brand Family Name of Cigarettes
RYO Tobacco Sold in Nebraska
You Purchased the Cigarettes
Cigarettes Stamped and Sold in
or RYO Tobacco
Ounces
Equivalent
or RYO Tobacco
Nebraska for Each Brand
1 Total number of individual cigarettes and ounces/equivalent
cigarettes of RYO tobacco (total of all lines in Columns C and D or
from your attached printout). Do not add lines 1 and 1a together............ 1
1a
2 Enter the total number of individual cigarettes reported on Form 55
for the same tax period covered by this report (total of line 20 or 26
multiplied by 20 plus the total of line 20A or 26A multiplied by 25).......... 2
3 Subtract line 2 from line 1 ........................................................................ 3
Please explain any difference in the number of cigarettes.
You must provide the name of an individual that the Department of Revenue or Attorney General’s Office may contact for the purpose of
obtaining information regarding this report.
Name of Authorized Contact Person
Title
(
)
(
)
Daytime Telephone Number
FAX Number
E-mail Address
Under penalties of law, I declare that I have examined this report, including accompanying schedules and statements, and
to the best of my knowledge and belief, it is correct and complete.
sign
here
Authorized Signature
Authorized Signature
Authorized Signature
Authorized Signature
Signature of Preparer Other than Taxpayer
Signature of Preparer Other than Taxpayer
Signature of Preparer Other than Taxpayer
Signature of Preparer Other than Taxpayer
Title
Date
Address
Date
Check our Web site for the Directory of Cigarettes and Roll-Your-Own Tobacco Products that are approved for sale in Nebraska
.
INSTRUCTIONS
together and enter that number for each brand family on
COLUMN A. Print the name of the supplier from whom
the corresponding line under Column C.
your company purchased each brand family of cigarettes
that your company stamped and sold in Nebraska for the
COLUMN D. Enter the total number of ounces of RYO
tax period covered by this report and any roll-your-own
tobacco products by brand family that your company
(RYO) tobacco that was reported on your Nebraska Tobacco
reported on Form 56 and sold in Nebraska.
Products Tax Return, Form 56, and sold to customers in
Convert the number of ounces to equivalent cigarettes. To
Nebraska.
convert ounces to equivalent cigarettes divide ounces by .09.
COLUMN B. Print the brand family name of the RYO
Roll-your-own (RYO) tobacco. RYO tobacco is any
tobacco sold in Nebraska and any cigarettes that you
tobacco which, because of its appearance, type, packaging,
stamped and sold in Nebraska.
or labeling is suitable for use and likely to be offered to, or
COLUMN C. Enter the total number of individual cigarettes
purchased by, consumers as tobacco for making cigarettes.
by brand family that your company stamped and sold
LINE 2. Enter the total number of individual cigarettes
in Nebraska to consumers, retailers, and other Nebraska
stamped and sold as reported on your Nebraska Cigarette
licensed cigarette wholesale dealers.
Tax Report, Form 55, for the same tax period. To calculate
Example: Determine the total number of packs or
the number of individual cigarettes to report on line 2, add
cartons of each brand family of cigarettes stamped
together the number of packs reported on line 20 or line 26
for Company X. Multiply the total number of packs
and line 20a or line 26a, Form 55, multiplied by 20 and 25
or cartons of cigarettes by the number of individual
cigarettes respectively. Add these two amounts together and
cigarettes in each pack or carton. Add these numbers
report the total number of individual cigarettes on line 2.
Mail this form to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 94818, LINCOLN, NE 68509-4818
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