Form Wv/tpt-722 - West Virginia Application For Refund/credit Of Tobacco Tax
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2STATE OF WEST VIRGINIA
State Tax Department, Tax Account Administration Div
P.O. Box 2991
Charleston, WV 25330-2991
Craig A. Griffith, Tax Commissioner
Earl Ray Tomblin, Governor
Name
Address
Account #:
City
State
Zip
WV/TPT-722
WEST VIRGINIA APPLICATION FOR REFUND/CREDIT OF TOBACCO TAX
rtL194 v.3-Web
NOTE: This form has been redesigned. To avoid delays in the processing of this form, DO NOT use any older forms you may have. For
information regarding the State Tax Department’s new computer system, visit our website at
SECTION 1 - ERRONEOUS PAYMENT INFORMATION
DATE (MM/YYYY)
AMOUNT
1. Erroneous Payment
.
SECTION 2 - CIGARETTE
REASON
QUANTITY
TAX RATE
DATE (MM/YYYY)
AMOUNT
(Attach Affadavit for Lines 2, 3, 6, & 7)
Cigarette Packages of 20 Returned to
2.
0.5500
.
Manufacturer with WV Stamps Affixed
Cigarette Packages of 25 Returned to
3.
0.6875
.
Manufacturer with WV Stamps Affixed
4.
Stamps Returned to Commissioner (20's)
0.5500
.
5.
Stamps Returned to Commissioner (25's)
0.6875
.
6.
Certified Loss (20's)
0.5500
.
7.
Certified Loss (25's)
0.6875
.
- OTHER TOBACCO PRODUCTS
REASON
VALUE
TAX RATE
DATE (MM/YYYY)
AMOUNT
(Attach Affadavit)
8.
Certified Loss
0.0700
.
.
SECTION 3 - REFUND/CREDIT CALCULATION
DISCOUNT
AMOUNT
9.
Total Amount of Line(s) 2 through 8
.
10.
Less STATUTORY DEDUCTION (WV Code 11-17: Line 9 multiplied by discount rate)
0.0500
.
11.
Less DEALER'S DISCOUNT (Line 9 multiplied by discount rate)
0.0400
.
12.
For REFUND, enter Line 9 minus the sum of Line 10 and Line 11, else enter 0
.
13.
For CREDIT, enter Line 9 minus the sum of Line 10 and Line 11, else enter 0
.
Sign Your Application
(Signature of Taxpayer)
(Name of Taxpayer - Type or Print)
(Title)
(Date)
(Person to Contact Concerning this Return)
(Telephone Number)
(E-mail Address)
MAIL TO: WEST VIRGINIA STATE TAX DEPARTMENT
Tax Account Administration Div
P.O. Box 2991, Charleston, WV 25330-2991
FOR ASSISTANCE CALL (304) 558-3333 TOLL FREE (800) 982-8297
For more information visit our web site at:
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5
9
0
6
0
9
0
1
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File online at https://mytaxes.wvtax.gov
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