Form B-A-6 - Monthly Return Of Nonresident Cigarette Distributor

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B-A-6
Monthly Return of Nonresident
Web
Cigarette Distributor
8-12
North Carolina Department of Revenue
DOR Use Only
Application
Beginning
Ending
for Period
(MM-DD-YY)
(MM-DD-YY)
Legal Name (First 35 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
FEIN or SSN
Trade Name
Mailing Address
NCDOR ID/License Number
City
State
Zip Code
Name of Contact Person
State of Domicile
Fill in circle if applicable:
Phone Number
Fax Number
Amended Return
Schedule A. Cigarettes Sold in North Carolina During the Month and Computation of Cigarette Excise Tax
Column A
Column B
List in Packs of:
Packs of Cigarettes Sold in North Carolina
Twenty
Twenty-Five
1. Number of Packs of Cigarettes Sold in North Carolina on
,
,
,
,
which North Carolina Cigarette Excise Tax is to be
1.
Computed (Attach a list indicating name of each customer,
address, dates & number of packs sold)
2. Tax Rate: 2.25¢ per cigarette
45¢
56.25¢
2.
(Pack of 20, Rate 45¢; Pack of 25, Rate 56.25¢)
,
,
,
,
.
.
3. Total Excise Tax Due
3.
00
00
Multiply Line 1 by Line 2
,
,
.
4. Total Tax
4.
00
Add Column A and Column B on Line 3
5. Discount
,
,
.
Multiply Line 4 by 2% if return with full
5.
00
payment is timely filed; otherwise enter zero.
,
,
.
6. Net Excise Tax Due
6.
00
Line 4 minus Line 5
7. Penalty (10% for late payment; 5% per month,
,
,
.
maximum 25%, for late filing.) Multiply Line 4 by rate
7.
00
above if return with full payment is not filed timely.
8. Interest (See the Department’s website,
,
,
.
, for current interest rate.)
8.
00
Multiply Line 4 by applicable rate if return
with full payment is not filed timely.
,
,
.
$
9. Total Payment Due
9.
00
Add Lines 6 through 8
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
For your convenience, electronic payment methods are available through our website at .
Returns are due within twenty days after the end of each month. Form B-A-7, Tobacco Return Tax-Paid Products of Nonparticipating
Manufacturers, must be filed with this return. Mail this form with your check or money order in U.S. currency from a domestic bank to:
North Carolina Department of Revenue, PO Box 25000, Raleigh, North Carolina 27640-0110

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