Form B-A-18 - Application For Cigarette Excise Tax Refund For North Carolina Tax-Paid Packs Returned To Manufacturer

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B-A-18
Application for Cigarette Excise Tax
Web
Refund for North Carolina Tax-Paid Packs
8-12
Returned to Manufacturer
North Carolina Department of Revenue
DOR Use Only
Return for Month Ended
(MM-DD-YY)
(Date returned to manufacturer)
Legal Name (First 35 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
FEIN or SSN
Trade Name
Mailing Address
State
City
Zip Code
NCDOR ID/Account Number
State of Domicile
Name of Contact Person
Phone Number
Fax Number
Column B
Column A
Column C
Computation of Refund for North Carolina Tax-Paid
Record in Packs of:
Cigarettes On or After September 1, 2009
Twenty-Five
Other (Specify)
Twenty
,
,
,
1.
Total North Carolina Tax-Paid Packs
1.
Returned to Manufacturer
2.
Refund Rate: 2.25¢ Per Cigarette
45¢
56.25¢
.
2
(Pack of 20, Rate 45¢; Pack of 25, Rate 56.25¢)
,
,
,
3.
.
.
.
Refund Due
3.
00
00
00
Multiply Line 1 by Line 2
,
,
.
4.
Total of Columns A, B and C
4.
00
(From Line 3)
,
,
5.
.
Discount
5.
00
Multiply Line 4 by 2%
6.
,
,
.
Total Refund Due
6.
00
Line 4 minus Line 5
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
An original manufacturer’s affidavit MUST be attached to this application. Absent conclusive proof that the cigarettes
were returned to the manufacturer at the tax rate effective on or after September 1, 2009, the total North Carolina
tax-paid packs will be refunded at the 2.25¢ per cigarette rate. Form B-A-7, Tobacco Report Tax-Paid Products of
Nonparticipating Manufacturers, must be filed with this return when cigarettes are returned to a nonparticipating
manufacturer.
North Carolina Department of Revenue, PO Box 25000, Raleigh, North Carolina 27640-0110

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