Form M-19 - Cigarette And Tobacco Products Monthly Tax Return Form - State Of Hawaii - Department Of Taxation

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State of Hawaii — Department of Taxation
FORM M-19
(Rev. 2006)
Cigarette and Tobacco Products
Monthly Tax Return
Caution: Use Form M-19 (Rev. 2006) for sales, use, or possession of cigarettes and tobacco products after September 30, 2006. For sales, use, or
possession of cigarettes and tobacco products occurring after June 30, 2004, and before October 1, 2006, use Form M-19 (Rev. 2004).
£
£
Name
Check one:
Original
Amended
Doing Business As
Month
Calendar Year
Mailing Address
Cigarette Tax and Tobacco Tax
License Number
City, State, Zip Code
Federal Employer ID No./Social Security No.
Contact Name
Telephone Number
TOBACCO PRODUCTS
1.
Wholesale sales for the month .................................................................................................................................................
1
2.
Retail sales for the month.........................................................................................................................................................
2
3.
Taxable use of tobacco products..............................................................................................................................................
3
4.
Total tobacco products (add lines 1, 2, and 3)..........................................................................................................................
4
5.
Less non-taxable sales (from page 2, Part I, Non-Taxable Sales of Tobacco Products) .........................................................
5
6.
Total taxable tobacco products (line 4 minus line 5) ................................................................................................................
6
7.
Tobacco tax (multiply line 6 by 40%) ........................................................................................................................................
7
8.
Refund of cigarette tax paid with cigarette tax stamps (from page 3, Part II, line 6) ................................................................
8
9.
Total Tobacco Tax Due (line 7 minus line 8) ............................................................................................................................
9
10. Penalty (5% per month to a maximum of 25%) ........................................................................................................................
10
11. Interest (2/3 of 1% per month to a maximum of 8% per annum) ..............................................................................................
11
12. Total Amount Due With Return (add lines 9, 10, and 11) .........................................................................................................
12
I declare, under the penalties set forth in section 231-36, HRS, that this is a true, correct, and complete return, prepared in accordance with the provisions of
chapter 245, HRS, the Cigarette Tax and Tobacco Tax Law, and chapter 18-245, HAR.
Signature
Title
Print name of signatory
Date
MAILING ADDRESSES
Oahu District Office
Maui District Office
Hawaii District Office
Kauai District Office
P. O. Box 259
P. O. Box 1169
75 Aupuni St. #101
3060 Eiwa St. #105
Honolulu, Hawaii 96809-0259
Wailuku, Hawaii 96793-6169
Hilo, Hawaii 96720-4245
Lihue, Hawaii 96766-1889
Telephone: (808) 587-4242
Toll-Free: 1-800-222-3229
Toll-Free: 1-800-222-3229
Toll-Free: 1-800-222-3229
Toll-Free: 1-800-222-3229
FORM M-19

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