Form B-A-45 - Statement Of Inventory For 2009 Cigarette Excise Tax Increase
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1
2Statement of Inventory for 2009
B-A-45
Web
Cigarette Excise Tax Increase
8-12
North Carolina Department of Revenue
DOR Use Only
Effective date
(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/Account Number
City
State
Zip Code
Name of Contact Person
State of Domicile
Fill in circle if applicable:
Phone Number
Fax Number
Amended Return
Part 1. Computation of Increased N.C. Cigarette Excise Tax
Column A
Column B
Inventory of North Carolina Tax-Paid Cigarette
List in Packs of:
Packs on September 1, 2009
Twenty
Twenty-Five
,
,
.
,
,
.
1. Number of Saleable North Carolina Tax-Paid Packs of Cigarettes
1.
00
00
,
,
.
,
,
.
2. Number of Unsaleable North Carolina Tax-Paid Packs of Cigarettes
2.
00
00
3. Total North Carolina Tax-Paid Packs of Cigarettes
.
.
,
,
,
,
3.
00
00
Add Lines 1 and 2
4. Additional Tax - .50¢ Per Cigarette
10¢
12.50¢
4.
(Pack of 20, Rate 10¢; Pack of 25, Rate 12.50¢)
,
,
.
,
,
.
5. Additional Excise Tax Due
5.
00
00
Multiply Line 3 by Line 4
,
,
.
6. Additional Tax
6.
00
Add Column A and Column B on Line 5
7. Penalty
(10% for late payment; 5% per month, maximum
,
,
.
25%, for late filing) Multiply Line 6 by rate above if return
7.
00
with full payment is not filed timely.
8. Interest
(See the Department’s website, ,
,
,
.
8.
for current interest rate.) Multiply Line 6 by applicable rate
00
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.
Reports are due by September 21, 2009. 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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