Tobacco Tax Reporting Form
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1REVENUE DIVISION
STATE OF ARKANSAS
Miscellaneous Tax Section
Department of Finance
P. O. Box 896 - Room 2240
th
1816 W. 7
Street
and Administration
Little Rock, Arkansas 72203
Telephone: 501-682-7185
FAX: 501-683-3699
Mary.Roddy@dfa.arkansas.gov
TOBACCO TAX REPORTING FORM
(Effective 3/1/2009)
Taxpayer: _____________________________________
Permit #: ___________
Report month: ____________
Contact person: ____________________________________________ Telephone #: ______________________
Mailing address:
__________________________________________________________________________________________________
(Street address / P.O. Box)
(City)
(State)
(Zip Code)
Email address:
___________________________________________________________________________________________________
The following report & information is required and submitted in compliance with Arkansas Codes § 26-57-208, 26-57-803, 26-57-1102, 26-57-805,
Act 180 of 2009, and 26-18-101 (Arkansas Tax Procedures Act).
TAX CALCULATION:
1. Total manufacturer’s cost of products sold…………………………………………………….……………
$ __________________________
2. Less: Cost of returns to manufacturers (only those products for which tax has been previously paid)..
$ __________________________
3. Less: Cost of those products sold through interstate sales………….……….……………………………
$ __________________________
4. Less: Cost of those products sold to Federal Institutions ………………………………………….………
$ __________________________
5. Less: Other cost of products sold that should not be subject to tax….……….………………….………
$ __________________________
TAXABLE NET COSTS RELATED TO ARKANSAS SALES
6.
..…....………
$ __________________________
X .68
7. Arkansas Tobacco Tax Rate (effective March 1, 2009)……………………..….…………….……………
8. Total Arkansas Tobacco Tax Due….…………………………………………………………………….…
$ __________________________
9. Less: Two Percent (2%) of Total Arkansas Tobacco Tax Due..…………………….……..……………
$ __________________________
th
(This discount is not to be taken unless this report & tax due are mailed by the 15
of the month.
To compute the 2% discount, multiply Line 8 by .02 and enter on Line 9 )
10. Net Arkansas Tobacco Tax Due (Line 8 minus Line 9)..……………….. ………………………………..
$ __________________________
11. Penalty due (months late ___________ X .05 X Line 8 (Not to exceed thirty-five percent (35%) )….
$ __________________________
12. Interest due (months late ___________ X .00833 X Line 8) …………………….….………………….
$ __________________________
TOTAL AMOUNT DUE (
13.
Add Lines 10, 11, and 12)……………………..………….………………
$
(Class Code 5311)
Miscellaneous Tax Section
Mail with remittance to:
-NOTICE-
P. O. Box 896 - Room 2240
Tobacco Excise Tax Report
th
1816 W. 7
Street
is due on or before the 15th
Little Rock, Arkansas 72203
of the month
I declare under penalties prescribed by the Arkansas Tobacco Tax Laws and the Arkansas Tax Procedures Act that this document, along with
any supporting schedules, are true and correct.
Official Use Only
_________________________________________________
_____/_____/_____
Check No.: _____________
(Signature)
(Date)
Check Amt: $___________
MT – Tobacco Tax Reporting Form. (revised 2/09)
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