Form Tb-1 - Vermont Wholesale Tobacco Dealer Report Page 2
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1
2Dealer’s Name____________________________________________________
Month/Year _________________________
Schedule A
Invoice Date
Invoice Number
To Whom Sold or Shipped
Address
“Wholesale Price”
Cigar Schedule B
CATEGORY I. Tax on cigars with wholesale price of $2.17 or less
14. Wholesale value of cigars (Multiply tax included price by .521) . . . . . . . . . . . . . . .14._________________________
15. Less: Exempt Sales (Shipped out of state) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15._________________________
16. Amount subject to tax (Line 14 minus Line 15) . . . . . . . . . . . . . . . . . . . . . . . . . . . .16._________________________
17. Tax Due (Line 16 x 92%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17._________________________
CATEGORY II. Tax on cigars with wholesale price of $2.18 - $9.99
18. Number of cigars sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18._________________________
19. Less: Exempt Sales (Shipped out of state) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19._________________________
20. Total cigars subject to tax (Line 18 minus Line 19) . . . . . . . . . . . . . . . . . . . . . . . . .20._________________________
21. Tax Due (Line 20 x $2.00) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21._________________________
CATEGORY III. Tax on cigars with wholesale price of $10.00 or greater
22. Number of cigars sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22._________________________
23. Less: Exempt Sales (Shipped out of state) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23._________________________
24. Total cigars subject to tax (Line 22 minus Line 23) . . . . . . . . . . . . . . . . . . . . . . . . .24._________________________
25. Tax Due (Line 24 x $4.00) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25._________________________
26. Total Tax Due (Add Lines 17, 21, and 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26._________________________
Transfer this amount to Form TB-1, line 9 and attach this schedule to the report.
Form TB-1
(Rev. 01/12)
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Parent category: Financial