2004
REVENUE USE ONLY
Form
Clear Form
Date Received
OREGON QUARTERLY TAX RETURN
•
532
FOR MANUFACTURERS DISTRIBUTING
NONEXEMPT TOBACCO PRODUCTS
Quarter Dates
Due Date
Program Code
Year
Period
Liability
Payment Received
1
•
•
•
•
•
01/01/04–03/31/04
April 30, 2004
532
04
03
1
Federal Identification No.
Quarter
Oregon Business Identification No.
•
Please use blue or black ink when filling out this form.
Type of business:
Corporation
Partnership
Individual
Other: ________________________
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1. Number of cigars at wholesale price of 77 cents or more .......................... 1
2. Multiply the number of cigars by 50 cents (line 1 × 0.50) ............................................................ 2
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3. Wholesale price of cigars at wholesale price of less than 77 cents .......... 3
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4. Wholesale price of all other tobacco products .......................................... 4
5. Total of lines 3 and 4 ................................................................................. 5
6. Multiply line 5 by 0.65 .................................................................................................................. 6
7. Total quarterly tax (add lines 2 and 6) ......................................................................................... 7
8. Quarterly tax discount (multiply line 7 by 0.015) .......................................................................... 8
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9. Net tax due (line 7 minus line 8) .................................................................................................. 9
10. Penalty and interest (see instructions) ...................................................................................... 10
11. Total amount due (add lines 9 and 10) .................................................................................... 11
DECLARATION
I declare under the penalties for false swearing [ORS 305.990(4)] that I have examined this document and to the best of
my knowledge it is true, correct, and complete.
Signature
Social Security No.
Date
PRINT Name Signed Above
Title
Telephone No.
(
)
150-605-005 (Rev. 12-03)
Please read the instructions