Commonwealth Of Pennsylvania Consumer Cigarette Excise Tax Return Form - 2004

ADVERTISEMENT

REV-791 AS (3-04)
PA DEPARTMENT OF REVENUE
COMMONWEALTH OF PENNSYLVANIA
BUREAU OF BUSINESS TRUST FUND TAXES
CONSUMER CIGARETTE EXCISE TAX RETURN
DEPT. 280909
HARRISBURG, PA 17128-0909
Any person who purchases cigarettes not bearing the PA cigarette tax stamp over the Internet, mail order catalogs or from other
cigarette retail stores located outside PA and brings the cigarettes into PA for consumption owes the Department of Revenue Cigarette
Excise Tax and Use Tax. Cigarette Excise Tax is based on a per-unit rate of $.0675 per cigarette. Use tax is 6% (7% in Allegheny and
Philadelphia Counties) of the selling price for items used or consumed in PA. This form is provided for the purpose of computing tax due
and remitting your tax payment to the above address. See reverse side for filing instructions.
Please print or type
Name
Social Security Number
Address
City
State
Zip
Month
Year
# of packs
Brand
Purchased from
10’s
20’s
25’s
1.
Name
Address
Date of purchase
Web site
Phone
2.
Name
Address
Date of purchase
Web site
Phone
3. a. Total Packs
x$.675
x$1.35
x$1.6875
b. Subtotal
=$
$
$
4. Total Cigarette Excise Tax Due:
$
(this is the sum of the subtotals on line 3b)
5.
Write the total purchase price of the cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
6.
Write the total amount of Cigarette Excise Tax due from Part 2 Line 4 . . . . . . . . . . . . . . . . . . . .$
7.
Add Lines 5 and 6. This is the total subject to Use Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
8.
Multiply the total on Line 7 by 6% (7% in Allegheny or Philadelphia Counties) Total Use Tax Due . . . . . . . . .$
9.
Add Lines 4 and 8 and remit this amount to the PA Department of Revenue . . . . . . . . . . . . . . . . . . . . . . . . . .$
Make checks payable to the PA Department of Revenue.
I declare that this form is correct and complete to the best of my knowledge and belief.
Signature
Date
Daytime phone
(
)

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form 1040-r - Springboro Individual Earnings Tax Return Form - 2004 Form 1040-r - Springboro Individual Earnings Tax Return Form - 2004 Financial
Form 404 - Commonwealth Of Virginia Department Of Taxation Soft Drink Excise Tax Return Form 404 - Commonwealth Of Virginia Department Of Taxation Soft Drink Excise Tax Return Financial
Form Liq-stc - Supplier Liquor Excise Tax Return Form Sales To Consumers Form Liq-stc - Supplier Liquor Excise Tax Return Form Sales To Consumers Financial
Form B-a-19 - Statement Of Basis For Cigarette Excise Tax Refund Form B-a-19 - Statement Of Basis For Cigarette Excise Tax Refund Financial
Form Ttb F 5000.24a - Excise Tax Return Form - Depatment Of The Treasury Form Ttb F 5000.24a - Excise Tax Return Form - Depatment Of The Treasury Legal
Cigarette Floor Tax Returns Form - Department Of Treasury - New Jersey Cigarette Floor Tax Returns Form - Department Of Treasury - New Jersey Financial
Form Ctx-ftr - City Of New York Cigarette Floor Tax Return - 2002 Form Ctx-ftr - City Of New York Cigarette Floor Tax Return - 2002 Financial
Form Alc 50008 - Oklahoma Retail Manufacturer Of Low Point Beer Excise Tax Return Form Alc 50008 - Oklahoma Retail Manufacturer Of Low Point Beer Excise Tax Return Financial
Form Ut 1014 - Ohio Consumer's Use Tax Return Form - Ohio Form Ut 1014 - Ohio Consumer's Use Tax Return Form - Ohio Financial
Form Q2/02 - Combined Excise Tax Return Form - 2002 Form Q2/02 - Combined Excise Tax Return Form - 2002 Financial

Related Categories

Parent category: Financial
Download
Go
Page of 2