Form Tob-101 - Delivery Sales Of Cigarette/other Tobacco Products To Persons In Indiana

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Indiana Department of Revenue
Mail To: Indiana Department of Revenue
TOB-101
P.O. Box 901
Delivery Sales of Cigarette/Other Tobacco Products
Indianapolis, IN 46206-0901
SF# 51418
to Persons in Indiana
(R2/05-07)
Delivery Sales of cigarettes/other tobacco products into the State of Indiana for the month ending __________/20________.
Due Date: 10th day of the calendar month following the month in which Cigarettes/Other Tobacco Products were shipped into the State of Indiana and where the appropriate
tobacco taxes were not collected from the purchaser.
Merchants Name
Federal FEIN or SSN
Mailing Address
Telephone Number
City
State
Zip Code
E-Mail Address
Contact Person
Title
Contact Telephone Number
Attach additional sheets as needed.
Invoice Date
Invoice
Purchaser’s
Purchaser’s
Product
Cigarette
Other Tobacco Products
Number
Name
Address
Brand
Number of
Sales Price
Wholesale Price
Sales Price
Cigarettes
Note: Your own form may be attached if it contains all the necessary information. (For example, a Computer Generated Report)
Delivery Sale - A delivery sale is defi ned in IC 24-3-5-1 as: A transaction for the purchase of tobacco products in which an offer to purchase tobacco products is made:
(1) electronically using a computer network (as defi ned in IC 35-43-2-3); (2) by mail; or (3) by telephone; and acceptance of the offer results in delivery of
tobacco products to a named individual at a designated address.
For questions related to this form, call (317) 615-2557

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