Form B-A-101 - Monthly Other Tobacco Products Excise Tax Return

Monthly Other Tobacco

B-A-101

Web

Products Excise Tax Return

4-10

North Carolina Department of Revenue

DOR Use Only

Application

Beginning

Ending

for Period

(MM-DD-YY)

Legal Name (First 35 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)

FEIN or SSN

Trade Name

NCDOR ID/License Number

Mailing Address

City

State

Zip Code

Fill in circle if applicable:

Name of Contact Person

Phone Number

State of Domicile

Payment has been made through

electronic funds transfer (EFT)

Computation of Other Tobacco Products Excise Tax Sold in Taxable Transactions

1. Cost Price of Other Tobacco Products Sold During the Month Cost price is the

price paid for the products before any discount, rebate or allowance. (Attach copies

of invoices or equivalent information.)

2. Cost Price of Other Tobacco Products Sold Outside North Carolina

(Attach copies of invoices or equivalent information.)

3. Cost Price of Other Tobacco Products Sold to the Federal Government or

Instrumentalities Thereof. (Attach copies of invoices or equivalent information.)

4. Cost Price of Other Tobacco Products Sold in Designated Sales Agreements

(See below for detailed instructions.)

5. Cost Price of Exempt Sales

Add Lines 2 through 4

6. Cost Price of Other Tobacco Products Sold in Taxable Transactions During the Month

Line 1 minus line 5

7. Tax Due

Multiply Line 6 by 12.8%

8. Discount

Multiply Line 7 by 2% if return with full payment is timely filed; otherwise enter zero.

9. Net Excise Tax Due

Line 7 minus Line 8

10. Penalty (10% for late payment; 5% per month, maximum 25%, for late filing)

10.

Multiply Line 7 by rate above if return with full payment is not filed timely.

11. Interest (See the Department’s website, , for current interest rate.)

11.

Multiply Line 7 by applicable rate if return with full payment is not filed timely.

12. Total Payment Due

12.

Add Lines 9 through 11

Designated Sales - A wholesale dealer who sells a tobacco product to a person who has notified the wholesale dealer in writing that the person intends to

resell the item in a transaction that is exempt from tax, such as a tobacco product sold outside the State or sold to the federal government, must maintain and

make available for inspection by the Secretary of Revenue a record of each exempt sale. These records must be kept separately from all other records.

Retail dealers and wholesale dealers liable for the excise tax on tobacco products other than cigarettes must file this return within twenty days

after the end of each month. A return must be filed even if no tax is due. Form B-A-7, Tobacco Report Tax-Paid Products of Nonparticipating

Manufacturers, must be filed with this return.

Signature:

Title:

Date:

I certify that, to the best of my knowledge, this return is accurate and complete.

Mail this form with your check or money order in U.S. currency from a domestic bank to:

North Carolina Department of Revenue, Excise Tax Unit, PO Box 25000, Raleigh, North Carolina 27640-0001

Department Use Only:

Date Audited:

Form B-A-101 - Monthly Other Tobacco Products Excise Tax Return - 2010

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