CIG 57
Rev. 3/09
Reset Form
P.O. Box 530
Columbus, OH 43216-0530
Ohio Cigarette Consumer’s Use Tax
Reporting Period
Ohio Revised Code (R.C.) section 5743.32 provides
that every person who has acquired cigarettes for
use, storage or other consumption in this state shall,
For the month of
, 20
on or before the 15th day of the month following
receipt of such cigarettes, make and fi le with the tax
Name
commissioner a return showing the amount of ciga-
rettes acquired, together with remittance of the tax
Address
thereon; provided that the tax levied in R.C. section
5743.02 and 5743.024 has not been paid.
City
State
ZIP
Instructions
Line 1 – This line should include cigarettes (sticks) shipped into all areas of Ohio except Cuyahoga County reported on the
schedule (see reverse side for the schedule to be completed and for a listing of municipalities in Cuyahoga County).
All lines on the return must be completed.
Line 2 – This is the Ohio tax rate.
Line 3 – Multiply line 1 by line 2. This is the tax due on the cigarettes (sticks) shown on line 1. (Ex. 1 carton = 200 sticks.)
Line 4 – This line should include cigarettes (sticks) shipped into Cuyahoga County.
Line 5 – This is the combined Ohio/Cuyahoga County tax rate.
Line 6 – Multiply line 4 by line 5. This is the tax due on the cigarettes (sticks) shown on line 4. (Ex. 1 carton = 200 sticks.)
Line 7 – Add lines 3 and 6. This amount is the total tax due. Make your check payable to the Ohio Treasurer of State.
If you have any questions, please call the Excise Tax Section at (855) 466-3921.
1. Total number of cigarettes (sticks) shipped into Ohio during report period
x
.0625
2. Tax rate ...................................................................................................
3. Tax liability (line 1 x line 2) ......................................................................................................... $
4. Total number of cigarettes (sticks) shipped into Cuyahoga County .......
x
.07975
5. Tax rate ...................................................................................................
6. Tax liability (line 4 x line 5) ......................................................................................................... $
7. Total due with this report (add lines 3 and 6) ............................................................................. $
I declare under penalties of perjury that this return (in-
cluding any accompanying schedules and statements)
Signature
has been examined by me and, to the best of my
knowledge and belief, is a true, correct and complete
return and report.
Title
Date
Mail report and check or money order covering tax due to the
Excise Tax Section, P.O. Box 530, Columbus, OH 43216-0530.