Form M-19 - Cigarette And Tobacco Products Monthly Tax Return Form - State Of Hawaii - Department Of Taxation Page 2

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FORM M-19
Page 2
(REV. 2006)
PART I - LIST OF NON-TAXABLE SALES
NON-TAXABLE SALES OF CIGARETTES:
Sales to the United States, including any agency or instrumentality thereof.
Note: Do not include in this list, sales of cigarettes that are shipped to a point outside the State for subsequent sale or use outside the State, including sales
made under section 212-8, HRS, to any common carrier for consumption out-of-state by the crew or passengers on such carrier; and sales by
wholesalers from U.S. licensed bonded warehouses to foreign fishing vessels and to common carriers for out-of-state consumption by the crew or
passengers. These sales should be listed on page 3, Part II, Refund of Cigarette Tax Paid With Cigarette Tax Stamps.
Number of
Name of Purchasers
Wholesale Value
Cigarettes
$
TOTAL (Enter totals here. Also enter total number of cigarettes on page 4,
Part IV, line 5)
$
NON-TAXABLE SALES OF TOBACCO PRODUCTS:
(1) Sales to the United States, including any agency or instrumentality thereof; or
(2) Sales that are shipped to a point outside the State for subsequent sale or use outside the State, including sales made under section 212-8, HRS, to any
common carrier for consumption out-of-state by the crew or passengers on such carrier; and sales by wholesalers from U.S. licensed bonded warehouses
to foreign fishing vessels and to common carriers for out-of-state consumption by the crew or passengers.
Exempt Category
Name of Purchasers
Wholesale Value
Indicate as
(1) or (2)
$
TOTAL (Enter total here and on page 1, line 5)
$

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