Form Rev-791 As - Consumer Cigarette Use/excise Tax Return For Cigarettes Purchased After Jan. 7, 2004

ADVERTISEMENT

REV-791 AS (4-05)
CONSUMER CIGARETTE USE/EXCISE
PA DEPARTMENT OF REVENUE
BUREAU OF BUSINESS TRUST FUND TAXES
TAX RETURN FOR CIGARETTES
PO BOX 280909
PURCHASED AFTER JAN. 7, 2004
HARRISBURG, PA 17128-0909
Any person who purchases cigarettes not bearing the PA cigarette tax stamp over the Internet, from 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 rate of $13.50 a carton for cigarettes purchased after January 7, 2004. 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 instructions.
Please print or type
Name
DOB MM/DD/Year
Social Security Number
Address
City
State
Zip
Cigarette Dealers License #
Brand
Date
Name of Business or Web site Cigarettes Were Purchased From
Cartons
1.
Address
Phone
Paid By
Brand
Date
Name of Business or Web site Cigarettes Were Purchased From
Cartons
2.
Address
Phone
Paid By
Brand
Date
Name of Business or Web site Cigarettes Were Purchased From
Cartons
3.
Address
Phone
Paid By
If you need additional space please copy this form, download the form from or contact the Department of Revenue.
4. Add cartons listed on Lines 1, 2 and 3 and enter total number of cartons purchased
The $13.50 per carton tax due for cigarettes purchased after Jan. 7, 2004
x
$13.50
5. Multiply total cartons purchased by $13.50 and enter total Cigarette Excise Tax Due
$
6. Enter the total amount you paid for all the cartons of cigarettes you purchased in Part 2, Line 4. . . . . . . . .$
7. Enter the total amount of Cigarette excise due from Part 2, Line 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
8. Add Lines 6 and 7 and enter the total amount that use tax is calculated on. . . . . . . . . . . . . . . . . . . . . . . . . .$
9. Enter 6% or 7% if you lived in Allegheny or Philadelphia Counties when you bought cigarettes. . . . . . . . . .x
%
10. Multiply the amount on Line 8 by the percentage on Line 9 and enter total use tax due . . . . . . . . . . . . . . . .$
11. Enter the total Cigarette excise tax due from Part 2, Line 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
12. Enter the total use tax due from Part 3, Line 10. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
13. Add Lines 11 and 12 and enter the total Cigarette exise and use tax due. . . . . . . . . . . . . . . . . . . . . . . . . . .$
Make checks payable to the PA Department of Revenue and Remit.
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 Dr-601-i - Florida Intangible Personal Property Tax Return For Individual And Joint Filers As Of January 1, 2004 Form Dr-601-i - Florida Intangible Personal Property Tax Return For Individual And Joint Filers As Of January 1, 2004 Financial
Form Rev-1716 As - Period Ending And Administrative Due Dates For The Remittance Of Employer Withholding And Filing Of Quarterly Returns And W-2 Forms - 2012 Form Rev-1716 As - Period Ending And Administrative Due Dates For The Remittance Of Employer Withholding And Filing Of Quarterly Returns And W-2 Forms - 2012 Financial
Form Rev-1716 As - Period Ending And Administrative Due Dates For The Remittance Of Employer Withholding And Filing Of Quarterly Returns And W-2 Forms - 2013 Form Rev-1716 As - Period Ending And Administrative Due Dates For The Remittance Of Employer Withholding And Filing Of Quarterly Returns And W-2 Forms - 2013 Financial
Form T-205 P - Individual Consumer's Use/sales Tax Return - 1999 Form T-205 P - Individual Consumer's Use/sales Tax Return - 1999 Financial
Form St-236 - Casual Or Use Excise Tax Return Form St-236 - Casual Or Use Excise Tax Return Financial
Form Rev 84 0004e (a) - Real Estate Excise Tax Refund Request Form Rev 84 0004e (a) - Real Estate Excise Tax Refund Request Financial
Form Rev-1630a As - Pa Underpayment Of Estimated Tax By Individual Farmers - 2015 Form Rev-1630a As - Pa Underpayment Of Estimated Tax By Individual Farmers - 2015 Financial
Form 990-bl - Information And Initial Excise Tax Return For Black Lung Benefit Trusts And Certain Related Persons Form 990-bl - Information And Initial Excise Tax Return For Black Lung Benefit Trusts And Certain Related Persons Financial
Form 990-bl - Information And Initial Excise Tax Return For Black Lung Benefit Trusts And Certain Related Persons Form 990-bl - Information And Initial Excise Tax Return For Black Lung Benefit Trusts And Certain Related Persons Financial
Form 990-bl - Information And Initial Excise Tax Return For Black Lung Benefit Trusts And Certain Related Persons Form 990-bl - Information And Initial Excise Tax Return For Black Lung Benefit Trusts And Certain Related Persons Financial

Related Categories

Parent category: Financial
Download
Go
Page of 2