Form Cig 51 - Claim For Reimbursement Of Cigarette Tax Illegally Or Erroneously Paid And/or Unused Cigarette Tax Stamps Page 2

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CIG 51
Rev. 3/09
Unused Combined Stamps
Page 2
20. 20 stamps ..........................
x
1.595
=
$
21. 25 stamps ..........................
x
1.99375 =
22. Total of lines 20 and 21...................................................................
23. Less dealers discount (line 22 x .018) ............................................=
24. Net amount (line 22 minus line 23) ................................................................................................ $
Unused County Only Stamps
25. 20 stamps ..........................
x
.345
=
$
26. 25 stamps ..........................
x
.43125 =
27. Total of lines 25 and 26...................................................................
28. Less dealers discount (line 27 x .018) ............................................=
29. Net amount (line 27 minus line 28) ................................................................................................ $
30. Total amount of claim (add lines 8, 11, 14, 19, 24 and 29)....................................................... $
See instructions below.
I have examined this claim and any adjustments in computation have been
For Departmental Use Only
explained to me by the agent.
Voucher No.
Signed
GRF
County Tax
Telephone number
Date
Instructions
cigarette manufacturer’s returned goods authorization,
The absence of complete records in the support of this claim
will constitute a justifi able ground for disallowance of the
a copy of the bill of lading showing the return of such
cigarettes to the manufacturer, an affi davit from the ciga-
claim by the department.
rette manufacturer acknowledging receipt of cigarettes
This claim for reimbursement must be fi led in accordance with
to which such stamps have been affi xed, and a copy of
the provisions relative thereto as set forth in Ohio Revised
the credit memorandum issued by the manufacturer.
Code section 5743.05. An application shall be fi led with the
Each dealer must assign a claim number to each claim
tax commissioner, on the form prescribed by him for such
submitted and shown in space provided for dealer tracking
purpose, after it is ascertained that the payment was erro-
neous, or from the date that cigarettes on which taxes have
purposes. This number must be in numerical sequence,
starting with No. 1. In this way, all dealers submitting claims
been paid have been sold in interstate or foreign commerce
will have a claim number sequence.
or have become unsalable; provided that in any event the
application for refund of taxes erroneously paid must be fi led
Original copy to be fi led with the Department of Taxation,
with the commissioner within three years from the date of
Excise Tax Unit, P.O. Box 530, Columbus, OH 43216-0530.
such erroneous payment.
Duplicate copy to be retained by applicant. If you have any
A claim for reimbursement of the tax represented by used
questions, please call the Excise Tax Unit at (855) 466-3921.
cigarette tax stamps must be supported by a copy of the

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