Reset
A
D
R
TOB: REF-WS
LABAMA
EPARTMENT OF
EVENUE
01/06
S
, U
& B
T
D
ALES
SE
USINESS
AX
IVISION
T
T
S
OBACCO
AX
ECTION
P. O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627
Wholesaler’s Refund Worksheet
–
________________________________________
1. Company Name
Permit No.
–
Telephone No. (
)
______________________________________________
Address
____________________________________________________
FEIN/SSN
CITY
STATE
ZIP
This worksheet must be completed by all wholesalers requesting refund or credit of state and state-administered county tobacco tax on
products which were returned to the manufacturer for credit. Complete a worksheet for EACH TYPE of tax, e.g. state or state-
administered county, and EACH tobacco product, e.g., cigarettes, snuff, smoking tobacco, etc. A separate worksheet must be
completed for EACH COUNTY also. See back of form for instructions.
Type of refund or credit (please check one):
State Cigarette Tax
State-Administered County Cigarette Tax ______________________________ (must indicate county – one county per worksheet)
State OTP Tax (must retain refund worksheet for audit purposes)
THIS WORKSHEET MUST BE COMPLETED IN DETAIL. SEE INSTRUCTIONS ON REVERSE SIDE.
2.
3.
4.
5.
6.
7.
8.
TAX VALUE
CREDIT / FOLIO
QUANTITY
TYPE OF PRODUCT/
TAX
TAX VALUE
MANUFACTURER
Other Tobacco Products (OTP)
NUMBER
(single pks.)
DESCRIPTION
RATE
Cigarettes Only
Only
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
9.
10.
0.00
TOTALS
According to Section 40-2A-7(c)(2)(a),
Cigarettes
OTP
Code of Alabama 1975, the statute of
0.00
11a.
11b.
limitations for filing a petition for
Gross Total . . . . . . . . . . . . . . . . . . . . . . . .
refund is two years from the date of
N/ A
0.00
12.
Less 7-1/2% Discount . . . . . . . . . . . . . . . .
payment of the tax, or three years from
the date the return was filed,
13a.
13b.
0.00
Net Amount of Refund or Credit . . . . . .
whichever is later.
NOTE: Use separate worksheets for
each product type.
Prepared By________________________________________ Date _____________
Do not combine products
on the same worksheet.
Title ______________________________________________