Form Fr-463 - Other Tobacco Products Floor Tax Return - 2010
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2DI ST DISTRICT OF COLUMBIA GOVERNMENT
Audit Division
OFFICE OF TAX & REVENUE
Cigarette Tax Enforcement Unit
P.O. Box 556
Washington, DC 20044
2010 OTHER TOBACCO PRODUCTS FLOOR TAX RETURN
RETAILERS, VENDING MACHINE OPERATORS AND STREET VENDORS
Due Date: January 21, 2010
See Instructions on Reverse Side
Name
FEIN#
D.C. Cigarette License #
Street Address
City
State
Zip Code
(A)
(B)
(C)
Quantity on Hand
as of
Floor Tax Rate/
Computed Tax
Product Type
January 1, 2010
Additional Tax
Column (A) x (B)
(net weight in ounces)
$.75 per ounce
$
1
Chewing Tobacco
$.45 per ounce
$
2
Moist Snuff
$.75 per ounce
$
3
Snuff (Other Than Moist)
$.75 per ounce
$
4
Roll-Your-Own Tobacco
$.75 per ounce
$
5
Hookah Tobacco
$.75 per ounce
$
All Other Tobacco Products Not Listed
6
Above
$
7
Total Tax Due
Under penalties of law, I declare that I have examined this return and, to the best of my
knowledge, it is correct.
_________________________________
_____________________________________
Print Name
Business Phone Number
_________________________________
________________________________
______________
Signature
Title
Date
FR-463 (Rev 12/09)
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