Form Tob: T-220a - Monthly State Tobacco Tax Return By Nonresident Distributors

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TOB: T-220A
7/02
A
D
R
OFFICE USE ONLY
LABAMA
EPARTMENT OF
EVENUE
S
, U
& B
T
D
Bank Deposit Date: ___________
ALES
SE
USINESS
AX
IVISION
Amount Paid: ________________
T
T
S
OBACCO
AX
ECTION
Checked By:________________
P.O. B
327555 • M
, AL 36132-7555 • (334) 242-9627
OX
ONTGOMERY
Monthly State Tobacco Tax Return By Nonresident Distributors
For the Month of _______________________, __________
(MONTH)
(YEAR)
NAME (PERSON, FIRM, OR CORPORATION)
FEIN / SSN
ADDRESS
PERMIT / REGISTRATION NUMBER
-
CITY
STATE
ZIP
TELEPHONE NUMBER
-
(
)
TOBACCO PRODUCTS OTHER THAN CIGARETTES ACTUALLY SOLD INTO ALABAMA DURING THE MONTH
A
B
C
D
E
TAX VALUE OF
TAX VALUE OF
TAX VALUE OF
TAX VALUE OF
TOTAL
(Tax Values Must Be Shown for Each Product Type)
SNUFF
CHEWING TOB.
SMOKING TOB.
CIGARS
TAX VALUE
1 Tax Value of All Products Sold in Alabama (Gross sales less
credit returns) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
$
$
$
LESS ADJUSTMENTS:
2 Sales to National Guard Units . . . . . . . . . . . . . . . . . . . . . . . . . .
3 Sales to United States Government . . . . . . . . . . . . . . . . . . . . .
4 Sales to Federally Recognized Indian Reservations. . . . . . . . .
5 Total Adjustments (Add lines 2 through 4 of each column). . . .
6 SUBTOTALS (Line 1 minus line 5 of each column) . . . . . . .
7 Less Credits (Attach letter from Department) . . . . . . . . . . . . . .
8 Gross Tax Value Due (Line 6 minus line 7 of each column)
Complete Schedule D (form TOB: SCH D) if an amount
is shown in column C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
$
$
$
$
9 Failure To Timely File Return Penalty (The greater of 10% of column E, line 8 or $50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
10 Failure To Timely Pay Tax Penalty (10% of column E, line 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
11 Interest (Contact the Department for rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
12 AMOUNT DUE (Add column E, lines 8 through 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
Check here if amount remitted through
Electronic Funds Transfer (EFT) . . . . . . . . . . . .
Under penalties of perjury, I hereby certify that the return made by me is true and correct.
SIGNATURE
TITLE
DATE
This tax return and the proper remittance must be filed with the Alabama Department of Revenue between the first and the twentieth of each
month for ALL tobacco products other than cigarettes sold and delivered into Alabama during the preceding month. Even if there is no activity
during the month, a tax return must be filed and marked “NO ACTIVITY.” The original tax return and remittance must be submitted to the
Alabama Department of Revenue at the address above. Retain a copy of the tax return and supporting documents in your files subject to
audit and inspection by the Alabama Department of Revenue.
Any wholesaler who refuses or fails to file the return and make the proper remittance within the time allowed may subject their stamping permit
to possible revocation (Sections 40-25-16 and 40-2A-8, Code of Alabama 1975).
All remittances, other than EFT, must be made by certified funds (e.g. cashier’s check or money order) unless properly bonded
(tobacco tax bond). Cash sent through the mail is sent at taxpayer’s risk. Separate checks must be remitted for state and county
payments.
SEE BACK FOR TAX RATES

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