Form B-A-7 - Tobacco Report Tax-Paid Products Of Nonparticipating Manufacturers

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B-A-7

Tobacco Report

Web

DOR Use Only

Tax-Paid Products of Nonparticipating Manufacturers

12-10

North Carolina Department of Revenue

Legal Name (First 35 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)

Application

Beginning

Ending

for Period

(MM-DD-YY)

Trade Name

FEIN or SSN

Fill in circle if applicable:

Mailing Address

Amended Return

City

Phone Number

state

Zip code

NcDoR ID/License Number

State of Domicile

Name of contact Person

Fax Number

INsTRucTIoNs

Complete the following table for all cigarettes by brand, including roll-your-own tobacco products, that were made by nonparticipating manufacturers and included in the products for which tax is reported on

Form B-A-5, B-A-6, B-A-15, B-A-18, B-A-19, B-A-101 or B-A-101R. Important: Form B-A-7 must be filed in duplicate with Forms B-A-5, B-A-6, B-A-15, B-A-18, B-A-19, B-A-101 and B-A-101R.

Tax-Paid Products of Nonparticipating Manufacturers

Number of

Roll-Your-Own

Number of

Name and Address of the

Name and Address of

Packs of

Person(s) From Whom Each

Brand Name

Packs of

Tobacco

First Importer of Foreign