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Form Fr-463 - Retail And Vending Machine Licensee Floor Stock Cigarette Tax Return Form - District Of Columbia Government Office Of Tax & Revenue Page 2

DISTRICT OF COLUMBIA GOVERNMENT

WHOLESALER OF D.C.CIGARETTE LICENSEE

FR-463

OFFICE OF TAX & REVENUE

FLOOR STOCK CIGARETTE TAX RETURN

(Rev 12/02)

(As of February 1, 2003)

Name

FEI Number

D.C. Cigarette License No.

Street Address

City

State

Zip Code

PHYSICAL INVENTORY

(1)

(2)

(3)

(4)

(5)

STAMPED

UNUSED

PACKAGES, &

TOTAL

HAND

ADDITIONAL

TAX DUE

ROLL/SHEET OF

(Col. & 2)

STAMPS

TAX

(Col. 3 x 4)

UNUSED STAMPS



.65¢

.35¢





81.25¢

43.75¢







TOTAL TAX DUE $

PENALTY FOR LATE PAYMENT (25%)

STATUTORY INTEREST .000355921 PERCENT PER DAY

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:

This return must be filed by the wholesaler of D.C. cigarettes and include all cigarette tax stamps held within or without the District of

Columbia as of the beginning of business February 1, 2003.

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.

The return must be signed by the owner, partner or duly authorized officer of the corporation and must be notarized.

Penalty and interest is applicable if filed after February 21, 2003.

WHOLESALERS

1. Report the physical inventory of stamped packages of cigarettes in Col. 1

2. Report the physical inventory of roll/sheet of unused cigarette stamps in Col. 2

Form Fr-463 - Retail And Vending Machine Licensee Floor Stock Cigarette Tax Return Form - District Of Columbia Government Office Of Tax & Revenue Page 2

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