Form Fr-463 - Retail And Vending Machine Licensee Floor Stock Cigarette Tax Return Form - District Of Columbia Government Office Of Tax & Revenue
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1
2DISTRICT OF COLUMBIA GOVERNMENT
RETAIL AND VENDING MACHINE LICENSEE
FR-463
OFFICE OF TAX & REVENUE
FLOOR STOCK CIGARETTE TAX RETURN
(Rev 12/02)
(As of February 1, 2003)
Name
FEIN #
D.C. Cigarette License #
Street Address
City
State
Zip Code
PHYSICAL INVENTORY
(1)
(2)
(3)
(4)
(5)
STAMPED
HAND
TOTAL
ADDITIONAL
TAX DUE
PACKAGES
STAMPS
(Col. & 2)
TAX
(Col. 3 x 4)
.65¢
.35¢
$
A
81.25¢
43.75¢
VENDING MACHINE (ALTERNATE METHOD)
B
NUMBERS OF MACHINES
@ $190.00
C
TOTAL TAX DUE $
D
PENALTY FOR LATE PAYMENT (25%)
E
STATUTORY INTEREST .000355921 PERCENT PER DAY
F
TOTAL AMOUNT DUE (C+D+E)
$
I hereby swear (affirm that this report has been examined by me and is to the best of my knowledge
and belief, a true and complete statement.
Authorized signature
Title
Date
IMPORTANT: THE RETURN MUST BE NOTARIZED
Subscribed and sworn to before me this
day of
,
.
My Commission expires:
.
1.
This return must be filed by retail and vending machine licensees and include all cigarette tax stamps held within or without the
District of Columbia as of the beginning of business February 1, 2003. Failure to file floor tax return may result in criminal
prosecution.
2.
The return must be filed on or before February 21, 2003 with payment by check or money order payable to the D.C. Treasurer. Mail
to the Office of Tax and Revenue, P.O. Box 556, Washington, DC. 20004.
3.
The return must be signed by the owner, partner or duly authorized officer of the corporation and must be notarized.
4.
Penalty and interest is applicable if filed after February 21, 2003.
A. RETAIL LICENSEES –
1.
Report the physical inventory of stamped packages of cigarettes in Col. 1
2.
Report the physical inventory of unaffixed hand cigarette stamps in Col. 2
B. VENDING MACHINE LICENSEES – ALTERNATE METHOD Instead of taking a physical inventory of cigarettes in
each vending machine, enter on Line B, Col. 3 the total number of machines located in the District of Columbia. If you elect the
alternate method, you must use such method for all machines. A list of vending machine locations must accompany this return
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