Form 70-099 - Iowa Vending Machine Monthly Tax Return (Sticks Assembled) (Page 2 of 4) in pdf

Iowa Vending Machine Monthly Tax Return (Sticks Assembled)

RETURN FOR MONTH OF

YEAR

Iowa Department of Revenue

DUE DATE: On or before the 10th day of the month for the

preceding calendar month.

FOR OFFICE USE ONLY

Postmark Date

LICENSE NO:

Audit Period

NAME:

Vending returns and all supporting documentation

ADDRESS:

are required to be maintained for five years.

MAIL TO: Iowa Department of Revenue, PO Box 10456,

Des Moines IA 50306

Include all Pipe Tobacco and Roll Your Own (RYO) product

Only approved brands of roll-your-own product may be sold in Iowa. Any product not

on the list is contraband. Go to

purchased this month (schedule P 1)

Section 1 – Number of RYO Ounces and Pipe Tobacco Ounces Purchased this Month

Total number of ounces puchased from Purchase Worksheet (form P1)………………………………..

Section 2 – Meter Reading for this Month

Beginning Meter Reading for this month …………………………………………………………………….

Ending Meter Reading for this month ……………………………………………………………………….

Difference - total number of sticks assembled for this month.……………………………………………

Section 3 – Computation of Tax Due

Total number of sticks assembled for this month (use difference from above) …………………………

Stick Rate for Vending Machine.......................................................................................

$0.0306

Vending Machine Stick Tax (multiply total sticks by stick rate) …………................................................

Total Vending Machine Stick Tax Due (amount from above)…………………........................................

Penalty, if applicable (10% of tax due, if 90% of the correct tax is not paid by the due date)…………………………..

Interest, if applicable (.007 per month, for each month late)…………………………………………….…………………..

TOTAL AMOUNT DUE: Make check payable to TREASURER STATE OF IOWA.........................

I declare that I have examined this return and attachments and to the best of my

knowledge and belief, it is a true, correct and complete return.

Telephone Number

Authorized Signature

Title of Officer

Date

Must attach Schedule P 1 unless zero for that schedule.

70-099a (05/25/12)

Form 70-099 - Iowa Vending Machine Monthly Tax Return (Sticks Assembled) Page 2