Form Ttb F 5000.28t09 - Floor Stocks Tax Return - Tobacco Products And Cigarette Papers And Tubes 2009 Page 2

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JULY 31, 2009
SECTION III – PAYMENT SUMMARY – PAY BY
18. METHOD OF PAYMENT (Check one box.)
CHECK
MONEY ORDER
EFT (Electronic Funds Transfer)
(See page 3)
OTHER (Specify)
Make check or money order payable to: ALCOHOL AND TOBACCO TAX AND TRADE BUREAU and include your EIN.
SECTION IV – CERTIFICATION
Under penalties of perjury, I declare that I have examined this return, including any supporting inventory records and
accompanying statements, and to the best of my knowledge and belief it is true, correct, complete, and includes all tax
liabilities required by law or regulation to be reported.
19. SIGNA
RE
20.
TLE
21. DAT
22. DAY ME TELEPHONE NUMBER
23. E-MAIL ADDRESS (Optional)
INSTRUCTIONS
SECTION I – TAXPAYER IDENTIFYING INFORMATION
SECTION IV – CERTIFICATION
Item 1. Verify and correct all pre-printed information.
Sign, enter your business title, and date your return. You
If you receive a blank tax return, enter your complete
must be authorized to act on behalf of the business.
business name, address, and ZIP Code in Item 1.
OTHER
Item 2. Enter your Employer Identification Number
Mailing. Use the enclosed self-addressed envelope to
(EIN).
submit your return, or mail it to:
Item 3. You must enter a number. Enter the number
Alcohol and Tobacco Tax and Trade Bureau
“1” if your return covers only one location. If you have
2009 Floor Stocks Tax
multiple locations with the same EIN, we encourage
P. O. Box 790208
you to file one return that covers these locations.
St. Louis, MO 63179-0208
SECTION II – CALCULATION OF TAXES
YOUR FLOOR STOCKS TAX RETURN MUST
Calculate tax only on articles held for sale on April 1,
BE POSTMARKED NO LATER THAN
2009. Do not include unmerchantable articles.
JULY 31, 2009.
* For large cigarettes longer than 6 ½ inches in length,
Records. Keep a copy of your inventory, tax return
the tax rate is the same as for small cigarettes, applied
and other supporting records available for inspection by
to each 2 ¾ inches or portion thereof as one cigarette.
TTB officers. Keep records for a period of at least 3
**For cigarette papers and cigarette tubes longer than
years after the due date of the return or the date you file
6 ½ inches in length, the tax rate is applied to each
your return, whichever is later.
2 ¾ inch or portion thereof as one paper or tube.
Penalties. Civil and criminal penalties may be imposed.
These penalties include failure to file, failure to pay, failure
See the accompanying publication for additional
to allow TTB officers access to premises where taxable
instructions concerning inventory, records and
articles are stored, failure to furnish officers access to
computation of tax due for this return.
records pertinent to tax liabilities, or filing a fraudulent
SECTION III – PAYMENT SUMMARY
return.
You must pay by EFT if you are currently required to
Questions. If you have questions about filing this return,
pay Federal tobacco excise tax by EFT. If not required,
contact your local TTB office or the National Revenue
you may voluntarily elect to pay this floor stocks tax by
Center, 550 Main Street, Suite 8002, Cincinnati, OH
EFT. EFT payments must be received on or before
45202-5215, telephone 1-877-882-3277 or 513-684-3334;
July 31, 2009. See for instructions on
or email us at FloorStocksTax@ttb.gov. Visit the Floor
making EFT payments.
Stocks Tax web page at for other helpful
tools and information.
Page 2 of 3
TTB F 5000.28T09 (0 /2009)

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