Form B-A-18cr - Application For Cigarette Excise Tax Refund For North Carolina Tax-Paid Packs Returned To Manufacturer

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Application for Cigarette Excise Tax
B-A-18CR
Web
Refund for North Carolina Tax-Paid Packs
9-09
Returned to Manufacturer
North Carolina Department of Revenue
DOR Use Only
Return for Month Ended
(MM-DD-YY)
Legal Name (First 35 Characters)
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
FEIN or SSN
Trade Name
Mailing Address
NCDOR ID/License Number
City
State
Zip Code
Name of Contact Person
Phone Number
State of Domicile
Column A
Column B
Column C
Computation of Refund for North Carolina Tax-Paid Cigarettes
On or After September 1, 2009
Record in Packs of:
Twenty
Twenty-Five
Other (Specify)
Packs of Cigarettes Returned to Manufacturer With NC Tax-Paid On or After to September 1, 2009
1.
Total North Carolina Tax-Paid Packs Returned to Manufacturer
1.
2.
Refund Rate: 2 1/4¢ Per Cigarette
.
45¢
56 1/4¢
2
(Pack of 20, Rate 45¢; Pack of 25, Rate 56 1/4¢)
$
$
$
3.
Refund Due
3.
(Multiply Line 1 by Line 2)
4.
Discount
4.
(
Multiply Line 3 by 2% if Form BA-5 or Form BA-6 was timely filed; otherwise enter zero.)
5.
Total Refund Due
5.
(Line 3 minus Line 4)
,
,
,
.
$
00
6.
Total of Columns A, B, and C.
6.
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
An original manufacturer’s affidavit MUST be attached to this application. Absent conclusive proof that the cigarettes were
returned to the manufacturer at the tax rate effective on or after September 1, 2009, the total North Carolina tax-paid packs
will be refunded at the 2 1/4¢ per cigarette rate.
North Carolina Department of Revenue, Tobacco Products Unit, PO Box 25000, Raleigh, North Carolina 27640-0110

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