Monthly Consignment Payment - Alabama Department Of Revenue
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1TOB: CNSG
2/10
A
D
R
LABAMA
EPARTMENT OF
EVENUE
OFFICE USE ONLY
S
, U
& B
T
D
• T
T
S
ALES
SE
USINESS
AX
IVISION
OBACCO
AX
ECTION
Certificate Date _____________________________________
Certificate Number ___________________________________
Reset
Monthly Consignment Payment
Folio Number_______________________________________
For The Month of ___________________________ , __________
(MONTH)
(YEAR)
COMPANY NAME
FEIN / SSN
ADDRESS
PERMIT NUMBER
CITY
STATE
ZIP
TELEPHONE NUMBER
(
)
–
CONTACT PERSON
E-MAIL ADDRESS
This form is to be completed by taxpayers acquiring cigarette stamps on consignment, that is, stamps acquired in one month with tax payment due by the 20th
of the next succeeding month. A separate form MUST be filled out for each payment made.
1. Complete A, B and C below regarding invoices for which payment is being made.
A. INVOICE DATE B.
INVOICE NUMBER
C.
AMOUNT OF PAYMENT
PLEASE MAIL FORM TO:
Alabama Department of Revenue
Sales, Use & Business Tax Division
Tobacco Tax Section
P.O. Box 327555
Montgomery, AL 36132-7555
2. Total of Invoices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(334) 242-9627
3. Lost Discount (Due to Payment Received
after 20th of month). . . . . . . . . . . . . . . . . . . . . . . . . . .
Tax payments equaling $750 or more in a given month obligates the
4. Total Tax Due (Add lines 2 & 3) . . . . . . . . . . . . . . . .
taxpayer to remit taxes by Electronic Funds Transfer (EFT). You may
5. 10% Late Payment Penalty (10% of line 4). . . . . . .
choose to make payment by EFT if the amount is less than $750.
6. Interest (Contact Department for rate) . . . . . . . . . . .
7. TOTAL PAYMENT(Add lines 4, 5 and 6) . . . . . . . .
SIGNATURE
DATE
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