Wholesaler'S Monthly Report Of State-Administered County Cigarette Products - Alabama Department Of Revenue

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A
D
R
TOB: T-WHSLE-CO
1/11
LABAMA
EPARTMENT OF
EVENUE
For Office Use Only
S
, U
& B
T
D
Reset
ALES
SE
USINESS
AX
IVISION
OVER: ___________________
T
T
S
SHORT: __________________
OBACCO
AX
ECTION
CHECKED BY: _____________
P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627 • Fax (334) 353-1011
Wholesaler’s Monthly Report of State-Administered County Cigarette Products
For the Month of ___________________________. __________
NAME
FEIN/SSN
ADDRESS
PERMIT/REGISTRATION NUMBER
CITY
STATE
ZIP
TELEPHONE NUMBER
–
(
)
This report must be filed with the Alabama Department of Revenue by the 20th of each month to report activity during the preceding calendar month in the below counties. A $50 penalty
will apply if the report is not filed timely. The report must be made in duplicate and is due regardless of activity. Mail the original report to the above address and retain a copy along with
detailed documentation in your files subject to audit and inspection by the Department of Revenue.
CIGARETTE TRANSACTIONS
CIGARETTE REVENUE STAMPS
1
2
3
4
5
6
7
8
9
10
11
12
13
COUNTY
COUNTY
TAX VALUE
TAX VALUE OF
NET CHANGE IN
STAMPED
STAMPED
STAMPED
TAX VALUE
INVENTORY OF
STAMPS
TOTAL STAMPS
INVENTORY OF
STAMPS AFFIXED
OVER STAMPED /
CODE
OF STAMPED
STAMPED
INVENTORY FOR
PRODUCTS SOLD
PRODUCTS
PRODUCTS
OF CIGARETTES
UNAFFIXED
PURCHASED
AVAILABLE
UNAFFIXED
DURING THE
(UNDER STAMPED)
CIGARETTE
CIGARETTE
THE MONTH
DURING THE
RETURNED TO
RETURNED TO
STAMPED DURING
STAMPS AT
DURING THE
(ADD COLUMNS
STAMPS AT
MONTH
FOR THE MONTH
INVENTORY AT
INVENTORY AT
(COLUMN 2 MINUS
MONTH
INVENTORY
MANUFACTURER
THE MONTH
BEGINNING OF
MONTH
8 AND 9)
END OF
(COLUMN 10 MINUS
(COLUMN 12 MINUS
BEGINNING
END OF MONTH
COLUMN 1)
DURING THE
DURING THE
(3 + 4 – 5 + 6)
MONTH
(FACE VALUE)
MONTH
COLUMN 11)
COLUMN 7)
OF MONTH
MONTH
MONTH
(FACE VALUE)
(FACE VALUE)
6 1
BARBOUR
9 5
BULLOCK
12 25
CHAMBERS
13 9
CHEROKEE
17 25
CLAY
22 5
COOSA
24 5
CRENSHAW
33 5
FRANKLIN
34 5
GENEVA
37 5
HENRY
38 5
HOUSTON
44 5
LIMESTONE
49 4
MARION
NOTE: THE TERM “STAMPED CIGARETTES” AS SHOWN ON THIS FORM INDICATE CIGARETTES WITH APPROPRIATE COUNTY STAMPS ATTACHED.

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