Other Tobacco Products Excise Tax Return Form Page 3
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5NEVADA DEPARTMENT OF TAXATION
TID & LOC:
OTHER TOBACCO PRODUCTS EXCISE TAX RETURN FORM #3
LICENSED DISTRIBUTOR REPORTING FORM FOR TOBACCO SALES OF NON-PARTICIPATING MANUFACTURER BRANDS
WHOLESALER:
FOR MONTH ENDING:
(A)
(B)
(C )
(D)
(E)
(F)
(G)
(H)
Brand Name
No. of Cigarettes Stamped
No. of Cigaretttes Stamped
Ounces of RYO Sold
Ounces of RYO Sold to
Non-Participating Manufacturer
Name and Address of
Name and Address of
with Nevada Indicia
with Tribal Indicia
where Nevada excise
Tribal entities – Do Not
Name and Address (if known)
the Person(s) From
First Importer of Foreign
Whom Each Brand
Manufactured Brands (if
tax has been paid – Do
Convert to Cigarettes
Not Convert to
Was Purchased
known)
Cigarettes
OTP-03
REVISED 01-01-08
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