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Form Op-300 - Tobacco Products Tax Return - Connecticut Department Of Revenue Services

FORM OP-300

STATE OF CONNECTICUT

DEPARTMENT OF REVENUE SERVICES

RETURN FOR PERIOD ENDED

TOBACCO PRODUCTS TAX RETURN

PO BOX 5018

HARTFORD CT 06102-5018

CT TAX REGISTRATION NUMBER

Important: Please see instructions on the back of this return.

(Rev. 07/00)

FEDERAL EMPLOYER ID NUMBER

PLEASE CHANGE YOUR NAME AND MAILING ADDRESS IF SHOWN INCORRECTLY

Check if applicable:

Final Return

(going out of business)

Amended Return

Tobacco Products (excluding snuff tobacco products)

Purchased, imported, received or acquired in Connecticut (from Schedule A-1 or A-2)

Tobacco Products (excluding snuff tobacco products)

Manufactured in Connecticut (from Schedule B)

3. Subtotal (Add Line 1 and Line 2)

Tobacco Products (excluding snuff tobacco products)

Exported from Connecticut (from Schedule C)

Tobacco Products (excluding snuff tobacco products)

Sold to the federal government (from Schedule D)

6. Subtotal (Add Line 4 and Line 5)

7. Amount subject to tax (Subtract Line 6 from Line 3)

8. TAX DUE ON TOBACCO PRODUCTS (Multiply Line 7 by 20% (.20))

9. TAX DUE ON SNUFF TOBACCO PRODUCTS (from Schedule A-3 or A-4)

10. TOTAL TAX DUE (Add Line 8 and Line 9)

11. PENALTY: 10% (.10) of total tax due or $50, whichever is greater

12. INTEREST: 1% (.01) per month or fraction thereof from due date to date of payment

13. TOTAL AMOUNT DUE (Add Lines 10, 11, and 12)

I declare under the penalty of false statement that I have examined this return, FORM OP-300, and, to the best of my knowledge and

belief, it is true, complete, and correct. (The penalty for false statement is imprisonment not to exceed one year or a fine not to exceed

two thousand dollars, or both.)

Signature

Title

Date

Print Name

Form Op-300 - Tobacco Products Tax Return - Connecticut Department Of Revenue Services