Form 5468 - State Tobacco Pact Act Pa-2 Report For Missouri
Download a blank fillable Form 5468 - State Tobacco Pact Act Pa-2 Report For Missouri in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 5468 - State Tobacco Pact Act Pa-2 Report For Missouri with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2Form
Missouri Department of Revenue
5468
State Tobacco PACT Act PA-2 Report for Missouri
Business Name (Please Print)
Missouri Tax Identification Number
Reporting Period (MM/YYYY)
___ ___ / ___ ___ ___ ___
|
|
|
|
|
|
|
Federal Employer Identification Number (FEIN)
Location Address
City
State or Province
Zip or Postal Code
Country or Territory
|
|
|
|
|
|
|
|
Mailing Address
City
State or Province
Zip or Postal Code
Country or Territory
E-mail Address
Manufacturer’s
RYO
OTP
Retail Sales
Invoice Date
Customer Name*
Address
Brand Family*
Invoice Number
Quantity*
or Wholesale List
Total Weight*
Total Weight**
Price ($) **
Price **
Totals
Delivery Service Name*
Address*
Phone Number*
(___ ___ ___)___ ___ ___-___ ___ ___ ___
(___ ___ ___)___ ___ ___-___ ___ ___ ___
*Required by Prevent All Cigarette Trafficking Act
** Delivery sellers only
Under penalties of perjury, I declare that the above information and any attached supplement is true, complete, and correct.
Signature of Responsible Party
Printed Name of Responsible Party
Phone Number
(___ ___ ___)___ ___ ___-___ ___ ___ ___
)
Title
E-mail Address
Date (MM/DD/YYYY
___ ___ / ___ ___ / ___ ___ ___ ___
Form 5468 (Revised 06-2013)
Mail to:
Taxation Division
Phone: (573) 751-5772
P.O. Box 811
Fax: (573) 522-1720
Visit dor.mo.gov/business/tobacco/ for additional information.
Jefferson City, MO 65105-0811
E-mail: excise@dor.mo.gov
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial