Other Tobacco Products Excise Tax Return Form Page 4
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5NEVADA DEPARTMENT OF TAXATION
TID & LOC:
OTHER TOBACCO PRODUCTS
EXCISE TAX RETURN FORM #4
FOR MONTH ENDING:
MAIL ORIGINAL TO: NEVADA DEPARTMENT OF TAXATION
1550 COLLEGE PARKWAY SUITE 115
CARSON CITY NV 89706
If the name or address shown is incorrect, if the ownership or business location has changed, or if you are out of business,
please contact the Carson City Department of Taxation
.
INVOICE
INVOICE
WHOLESALER PURCHASED PRODUCT FROM:
MONTH AND YEAR
TOTAL WHOLESALE
DATE
NUMBER
EXCISE TAX WAS PAID
PRICE/
TOTAL WHOLESALE PRICE
Instructions:
(1) Enter the invoice date, invoice number, name of wholesaler product was purchased from, date and year in which the tax was paid and reported to
Nevada, and the wholesale price of the product sold.
(2) Total the Wholesale Price column and enter the total wholesale price of the products sold.
OTP-03 Instructions
REVISED 03-01-11
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