Form Tc-553 - Tobacco Products Tax
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1Business Name:
Contact E-mail:
Address 1:
Contact Phone #:
Address 2:
Prepared By:
City:
Account #:
State:
FEIN:
Utah State Tax Commission
TOB
Zip:
Filing Period:
utah@utah.gov
P
Tobacco Products Tax
TC-553
Country:
Amended
Rev. 7/11
Part A: Moist Snuff (net weight in ounces)
1. Product received from manufacturer
OZ.
2. Product exported
OZ.
3. Tax-paid purchases included in line 1
OZ.
4. Other deductions (attach schedule and explanation)
OZ.
5. Total deductions (add lines 2, 3 and 4)
0.00
OZ.
6. Product for sale in Utah (line 1 less line 5)
OZ.
7. Tax rate
1.83
8. Net Tax Due (line 6 multiplied by line 7)
.00
Part B: Little Cigars (sticks)
1. Sticks received from manufacturer
2. Sticks exported
3. Tax-paid purchases included in line 1
4. Other deductions (attach schedule and explanation)
5. Total deductions (add lines 2, 3 and 4)
0
6. Sticks for sale in Utah (line 1 less line 5)
7. Tax rate
.085
8. Net Tax Due (line 6 multiplied by line 7)
.00
Part C: All other Tobacco Products (Dollars)
1. Total dollar value of product received from manufacturer
.00
2. Total dollar value of product exported
.00
3. Tax-paid purchases included in line 1
.00
4. Other deductions (attach schedule and explanation)
.00
5 Total deductions (add lines 2 3 and 4)
5. Total deductions (add lines 2, 3 and 4)
0
0
.00
00
6. Total dollar value of product for sale in Utah (line 1 less line 5)
.00
7. Tax rate
0.86
8. Net Tax Due (line 6 multiplied by line 7)
.00
Total tax due on all tobacco products (add Part A, line 8, Part B, Line 8 and Part C, Line 8)
0
.00
Under penalties of falsification, by marking this box and typing my name I declare that, to the best of my knowledge, all of the
information contained in this report and any attached documentation is true and accurate.
Name:
Title:
Check Box Declaration
Phone:
Date:
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