Form Tob 50017 - Oklahoma Tax Commission Consumer Tobacco Tax Return

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TOB 50017
Oklahoma Tax Commission Consumer Tobacco Tax Return
Revised 9-2011
Oklahoma Tax Commission
2501 North Lincoln Boulevard
Oklahoma City, OK 73194
Tobacco Tax is due on the 15th day of the month following date of purchase.
______________________________________________________________
___________________________________________
Consumer’s Name
Reporting Period
______________________________________________________________
___________________________________________
Address
Contact Telephone Number
______________________________________________________________
City
State
Zip
Smoking Tobacco (pipe tobacco, roll-your-own, tobacco wraps, etc.)
Product Type:
Seller’s
Seller’s Web Address
Transaction
Invoice
Brand Name of Other
Smoking Tobacco
Tax Due
Name
when Applicable
Date
Number
Tobacco Purchased
Price
Price X 80%
Chewing Tobacco (chew, plug, snuff, smokeless, etc.)
Product Type:
Seller’s
Seller’s Web Address
Transaction
Invoice
Brand Name of Other
Chewing Tobacco
Tax Due
Name
when Applicable
Date
Number
Tobacco Purchased
Price
Price X 60%
Little Cigars (must weigh less than 3 lbs. per thousand)
Product Type:
Tax Due
Seller’s
Seller’s Web Address
Transaction
Invoice
Brand Name of Other
Little Cigars
Number of Cigars
Name
when Applicable
Date
Number
Tobacco Purchased
Number of Cigars
X $0.036 each
Large Cigar (larger than 3 lbs. per thousand)
Product Type:
Tax Due
Seller’s
Seller’s Web Address
Transaction
Invoice
Brand Name of Other
Large Cigar
Number of Cigars
X $0.12 each
Name
when Applicable
Date
Number
Tobacco Purchased
Number of Cigars
Total Tobacco Tax Due
Interest
(Interest is 15% annually - 1-1/4% monthly beginning the day after the due date)
Penalty
(Penalty is 10% of the tax amount, once it becomes 30 days delinquent)
Total
I, the undersigned do declare under the penalties of perjury that this report, including the accompanying schedules which are made a part hereof, is to the best of my knowledge
and belief true and correct.
Signature
Date
See Reverse Side for Instructions and Mailing Address

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