Form 55 - Nebraska Cigarette Tax Report
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1
2Nebraska Cigarette Tax Report
FORM
for Resident and Nonresident Cigarette Wholesalers
55
• Read instructions on reverse side
nebraska
department
of revenue
RESET FORM
Nebraska Identification Number
Tax Period
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
To be Completed by Resident and Nonresident Wholesalers
Packs of 20 Cigarettes
Packs of 25 Cigarettes
1 Total stamps purchased this month ....................................................................
1
1a
2 Meter impressions purchased this month (see instructions) ...............................
2
2a
3 Beginning stamp inventory (line 6 and 6a of preceding month’s report) .............
3
3a
4 Beginning meter impressions (line 7 and 7a of preceding month’s report) .........
4
4a
5 Tax indicia available for use (total of lines 1 through 4 and 1a through 4a) .......
5
5a
6 Ending stamp inventory .......................................................................................
6
6a
7 Ending meter impressions inventory (see specific instructions) ..........................
7
7a
8 Total ending inventory (line 6 plus line 7 and line 6a plus line 7a) .....................
8
8a
9 Total tax indicia used (line 5 minus line 8 and line 5a minus line 8a) .................
9
9a
To be Completed by Resident Wholesalers Only
10 Total packs of cigarettes sold and delivered into other states ............................ 10
10a
11 Stamped packs of cigarettes purchased from other Nebraska wholesalers ....... 11
11a
12 Total packs of cigarettes sold to the U.S. government or its agencies ............... 12
12a
13 Other deductions ................................................................................................. 13
13a
14 Ending inventory of unstamped packs of cigarettes ............................................ 14
14a
15 Ending inventory of out-of-state stamped packs of cigarettes ............................ 15
15a
16 Total deductions (total of lines 10 through 15, and 10a through 15a) ................ 16
16a
17 Enter total of lines 14 and 15 and 14a and 15a of preceding month’s report ..... 17
17a
18 Total packs of cigarettes purchased this month .................................................. 18
18a
19 Packs available for sale (line 17 plus line 18, and 17a plus 18a) ....................... 19
19a
20 Taxable packs of cigarettes sold (line 19 minus line 16, and 19a minus 16a) .... 20
20a
21 If line 20 exceed line 9, or line 20a exceed line 9a, enter shortage .................... 21
21a
To be Completed by Nonresident Wholesalers Only
22 Beginning inventory (line 24 and 24a of preceding month’s report) ................... 22
22a
23 Stamped packs available for sale (line 9 plus line 22, and 9a plus 22a) ............ 23
23a
24 Ending inventory of stamped packs of cigarettes ................................................ 24
24a
25 Stamped packs to be accounted for (line 23 minus line 24, & 23a minus 24a) ... 25
25a
26 Actual Nebraska stamped packs of cigarettes sold ............................................ 26
26a
27 If line 26 exceeds line 25, or line 26a exceeds line 25a, enter shortage ............ 27
27a
Tax Computation — Resident and Nonresident Wholesalers
28 Tax due (line 21 or line 27 multiplied by $.64) .................................................... 28 $
29 Tax due ( line 21a or line 27a multiplied by $.80) ..................................................................................... 29
$
30 Total tax due (total of lines 28 and 29) ...................................................................................................... 30
31 Previous balance
31
32 BALANCE DUE (line 30 plus line 31). Pay in full with report .................................................................... 32
$
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
Authorized Signature
Signature of Preparer Other than Taxpayer
here
Title
Date
Address
Date
THIS REPORT IS DUE ON OR BEFORE THE 10TH DAY OF THE MONTH FOLLOWING THE TAX PERIOD INDICATED ABOVE
Mail this report and payment to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 94818, LINCOLN, NE 68509-4818
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