Form 73a421 - 2009 Inventory Floor Tax For Cigarettes, Other Tobacco Products (Otp), And Snuff Page 3
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32009 INVENTORY FLOOR TAX FOR
73A421A (3/2009)
CIGARETTES, OTHER TOBACCO PRODUCTS (OTP),
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
AND SNUFF
FOR INVENTORIES AS OF MARCH 31, 2009
INSTALLMENT PAYMENT 2 IS DUE MAY 10, 2009
Name and Address
Sales Tax Acct. No.
05 / 09
MM/YY
24. Remainder of Cigarette Inventory Floor Tax Due (line 16, page 1) . $
016-07
25. Installment Payment 2 for Cigarettes (at least 1/2 of line 24) ..........................................................$
26. Remainder Due for Cigarettes (line 24 minus line 25) ............... $
27. Remainder of OTP Inventory Floor Tax Due (line 19, page 1) .... $
28. Installment Payment 2 for OTP (at least 1/2 of line 27) .................................................................... $
101-03
29. Remainder Due for OTP (line 27 minus line 28) ......................... $
30. Remainder of Snuff Inventory Floor Tax Due (line 22, page1) .. $
31. Installment Payment 2 for Snuff (at least 1/2 of line 30) ................................................................. $
101-04
32. Remainder Due for Snuff (line 30 minus line 31) ....................... $
33. TOTAL DUE FOR INSTALLMENT 2 (line 25 plus line 28 plus line 31) .......................................................$
COMPLETE INSTALLMENT 3 IF LINE 26, 29, OR 32 IS NOT ZERO.
Name
Date
Signature
Telephone Number/E-mail
73A421B (3/2009)
2009 INVENTORY FLOOR TAX FOR
CIGARETTES, OTHER TOBACCO PRODUCTS (OTP),
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
AND SNUFF
FOR INVENTORIES AS OF MARCH 31, 2009
INSTALLMENT PAYMENT 3 IS DUE JUNE 10, 2009
Name and Address
Sales Tax Acct. No.
06 / 09
MM/YY
016-07
34. Installment Payment 3 for Cigarettes (line 26) ..................................................................................$
35. Installment Payment 3 for OTP (line 29) ............................................................................................$
101-03
36. Installment Payment 3 for Snuff (line 32) ......................................................................................... $
101-04
37. TOTAL DUE FOR INSTALLMENT 3 (line 34 plus line 35 plus line 36) .......................................................$
Name
Date
Signature
Telephone Number/E-mail
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