Tobacco Tax Report Form - City Of Northport
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1CITY OF NORTHPORT
(205) 339-7000
Fax (205) 333-3016
TOBACCO TAX REPORT
_____________________
REPORTING PERIOD
MAIL THIS RETURN WITH REMITTANCE TO:
CITY OF NORTHPORT
P.O. BOX 569
Taxpayer ID:
NORTHPORT, AL 35476
TOTAL AMOUNT ENCLOSED
$
□
□
Check here if this is a final return
Check here for additional forms
Out of Business Date: __________________
(A)
(B)
(C)
(D)
Type of Tax/Tax Area
Number Items Sold
Total Sold
Tax Rate
Gross Tax Due
(Column B x Column C)
Cigarettes
City
$0.10/pkg
Police Jurisdiction
$0.05/pkg
Cigars
City
$0.02/each
Police Jurisdiction
$0.01/each
Pack of Cigars
$0.02 times # in
City
each pack
$0.01 times # in
Police Jurisdiction
each pack
Smokeless Tobacco
City
$0.10/pkg
Police Jurisdiction
$0.05/pkg
Smoking Tobacco
City
$0.10/pkg
Police Jurisdiction
$0.05/pkg
(1) Total Tax Due
This Return must be post marked by the 20th day of the month
(Total of column D)
following the reporting period for which you filing to be considered
a timely return.
(2) Penalty
(failure to file greater of 10% or $50
By signing this report I am certifying that this report, including any
AND failure to pay 10%
accompanying schedules or statements, has been examined by me
(3) Interest
and is to the best of my
(Line 1 x 1% per month delinquent)
knowledge and belief, a true and complete report for the period
stated.
(4) Net Tax Due
(Lines 1+2+3)
Date ___________________ Title __________________________
Total Amount Due
& Enclosed
Signature ______________________________________________
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