REVENUE USE ONLY
2003 OREGON QUARTERLY TAX RETURN
Form
Date Received
Clear Form
•
531
FOR TOBACCO PRODUCTS
(Other than Licensed Distributor)
Reporting Period
Social Security No.
Oregon Business ID No.
Program Code Year
Period
Liability Payment Received
•
•
•
•
•
•
•
1st
531
03
03
1
Quarter: _______
Please use blue or black ink when filling out this form.
Type of business:
Individual
Partnership
Corporation
Other: ________________________
Please provide the following information:
A. Total price of all tobacco products purchased in the quarter ...................................................
B. Total price of cigars subject to the 50 cent limit purchased in the quarter ...............................
Complete Schedule A (below) before filling in lines 1–12.
•
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
•
3. Wholesale price of cigars at wholesale price of less than 77 cents .......... 3
•
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
•
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
Schedule A—
List each tobacco product purchased this quarter (add additional pages if needed).
Manufacturer or supplier
Invoice
Number of cigars
Wholesale price of products purchased
for whom tobacco products were purchased
Number
Date
b. Cigars—less than 77¢
c. Other tobacco products
a. Wholesale price of 77¢ or more
1.
2.
3.
4.
5.
6.
7a.
7b.
7c.
7.
Total wholesale price.
Enter totals for columns a and b. Enter amounts
from 7a, 7b, and 7c on corresponding lines 1, 3, and 4 at the top of the form.
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
Date
PRINT Name Signed Above
Title
Telephone No.
(
)
150-605-006 (Rev. 2-03)
Please read the instructions