MONTANA
CGT
Rev. 12-07
Cement and Gypsum Producers License Tax
For quarter ending __________________________________
Title 15, Chapter 59, Part 1, MCA
Name:
Address:
Address:
City:
State:
Zip Code:
1. FEIN:
2. Account ID:
3. Period:
4. If this is an amended return, check here.
5. If you are no longer in business and want your account cancelled, check this box
, enter the fi nal date. __________
6. If your mailing address has changed, check this box
and print new address below:
____________________________________________________________________
____________________________________________________________________
Quarterly Production Report
Tons
Rate
Tax Due
7. Number of tons of gypsum produced and sold as: gypsum,
land plaster, gypsum rock, or unprocessed gypsum ..............7.
X $0.05 = $
8. Number of tons of gypsum produced and made into plaster,
stucco, wallboard or other products of gypsum ......................8.
X $0.05 = $
9. Number of tons of gypsum or gypsum products containing not
less than 50% of gypsum imported into the state ...................9.
X $0.05 = $
10. Number of tons of cement manufactured in or imported into
the state ................................................................................10.
X $0.22 = $
11. Total Tax Due (add lines 7, 8, 9, and 10) ................................................................................... 11. $
Returns are due 30 days after the end of each calendar quarter. Penalties and Interest will be applied if late.
I hereby swear or affi rm under penalty of perjury that the statements contained herein are true to the best of my
knowledge.
Signature ___________________________________________
Title _______________________________________________ Phone __________________ Date ________________
Mail this return to:
Department of Revenue, PO Box 5805, Helena MT 59604-5805