Form B-A-5 - Schedule J - Cigarettes Returned To Manufacturer

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B-A-5
Cigarettes Returned to Manufacturer
Schedule J
North Carolina Department of Revenue
Web
4-11
Application for Period
Beginning
and ending
(MM-DD-YY)
(MM-DD-YY)
Legal Name of Owner (First 35 Characters)
(USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Trade Name
FEIN or SSN
Mailing Address
City
State
Zip Code
NCDOR ID/License Number
Name of Contact Person
State of Domicile
Phone Number
Fax Number
Part 1. Total Packs Returned to Manufacturer
Column A
Column B
Non-Tax-Paid in Packs of:
Twenty
Twenty-Five
,
,
,
,
1. Totals
Carry totals of Column A and B to Form B-A-5, Schedule A, Line 7
Column C
Column D
Tax-Paid in Packs of:
Twenty
Twenty-Five
,
,
,
,
2. Totals
Carry totals of Column C and D to Form B-A-5, Schedule D, Line 6 or Form B-A-6,
Schedule B, Line 5, whichever is applicable
Cigarettes returned to the manufacturer on Form B-A-5 or B-A-6 should include a Schedule J with completed Part 2 Detail
Summary. Failure to attach a complete Schedule J could result in the disallowance of a deduction or refund.
North Carolina Department of Revenue, PO Box 25000, Raleigh, North Carolina 27640-0001

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