Form 4426-25 - Out-Of-State Missouri Cigarette Wholesaler Monthly Cigarette Tax Report

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MONTH OF
FORM
MISSOURI DEPARTMENT OF REVENUE, TAXATION DIVISION
4426-25
P.O. BOX 811, JEFFERSON CITY, MO 65105-0811 (573) 751-7163
TDD 1-800-735-8966
OUT-OF-STATE MISSOURI CIGARETTE WHOLESALER
LICENSE NUMBER
(REV. 02-2012)
MONTHLY CIGARETTE TAX REPORT
WHOLESALER NAME
ADDRESS
E-MAIL ADDRESS
CITY, STATE, ZIP
TELEPHONE NUMBER
FAX NUMBER
(___ ___ ___) ___ ___ ___ -___ ___ ___ ___
(__ __ __) __ __ __ -__ __ __ __
FOR 25s ONLY
(B) ST. LOUIS
(C) JACKSON
(D) TOTAL OF
(A) STATE ONLY
MISSOURI STAMPS
COUNTY ONLY
COUNTY ONLY
COLUMNS A + B + C
1. Missouri stamped cigarettes on hand first of month ....................................................................
2. Missouri stamps unaffixed on hand first of month .......................................................................
3. Missouri stamped cigarettes purchased from another licensed wholesaler
during month (Schedule B-1) .......................................................................................................
4. Stamped cigarettes returned by customers during month ...........................................................
5. Missouri stamps purchased and received during the month (Form 304, Schedule C, Section 1)
6. Credit received in stamps during month (Form 304, Schedule C, Section 2) ..............................
7. Subtotal (Lines 1, 2, 3, 4, 5, and 6) .............................................................................................
8. Stamped cigarettes returned to manufacturer (Schedule B) .......................................................
9. Missouri stamped cigarettes on hand end of month ....................................................................
10. Missouri stamps unaffixed on hand end of month .......................................................................
11. Total tax inventory used during month (Line 7 less Lines 8, 9 & 10) ...........................................
12. *Stamped cigarettes sold into the State of Missouri (Attach Schedule F, F1 & F2).....................
*Line 11 should be the same as Line 12. If not, attach letter to report explaining the difference.
WHOLESALERS ON A DEFERRED PAYMENT BASIS MUST FILE THIS REPORT WITH
CASH PURCHASES
CREDIT PURCHASES
CALCULATION OF TAX DUE
THE TAXATION DIVISION AND PAY BALANCE DUE ON OR BEFORE THE FIFTEENTH
(15TH) DAY OF THE MONTH, COVERING ALL CIGARETTES AND TAX STAMPS RECEIVED
13. Stamps purchased during the month (Line 5, Column D) ..................
DURING THE MONTH. WHOLESALERS ON A CASH BASIS MUST FILE REPORT ON OR
BEFORE THE TWENTIETH (20TH) DAY OF THE MONTH.
14. Tax Due – Line 13 multiplied by $.2125 ............................................
15. Less: 3% of Line 14 (Discount is forfeited if not remitted on time). ....
NOTE: In the event that payment of the total deferment liability becomes delinquent after
fifteen (15) days from the first day of the month during which the purchases were made,
16. Subtotal (Line 14 less Line 15) ...........................................................
the Director may discontinue credit privileges, revoke the license held by the wholesaler
for a period of one year, and notify the bonding company requesting that payment be made
17. Less payments previously made ........................................................
under the terms of the bond.
18. AMOUNT DUE (Line 16 less Line 17), enter total on Form 4426-20,
Line 19) ..............................................................................................
I do hereby certify under penalty of perjury that the foregoing and attached reports are a true and correct statement to the best of my knowledge and a complete and full presentation of all transactions from the best information available. If you pay by check,
you authorize the Department of Revenue to process the check electronically. Any check returned unpaid may be presented again electronically.
PRINT NAME
SIGNATURE
TITLE
DATE
__ __ / __ __ / __ __ __ __
MAKE CHECKS PAYABLE TO MISSOURI DEPARTMENT OF REVENUE AND MAIL TO TAXATION DIVISION, P.O. BOX 811, JEFFERSON CITY, MISSOURI 65105-0811. If you have questions or need assistance in completing this form,
please call (573) 751-7163 or e-mail excise@dor.mo.gov. You may also obtain this form from the Department’s web site at: TDD (800) 735-2966
FORM 4426-25 (02-2012)

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