Form 620 - Maryland Consumer Premium Cigar Tax Return - 2013
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1
2MARYLAND CONSUMER
2013
FORM
620
PREMIUM CIGAR TAX RETURN
Period Ending (Month/Year)
Social Security Number
First Name
Initial
Last Name
Street Address
City
State
ZIP code
A
B
C
D
Date of
Quantity
Invoice
Purchase
Name and Address of Seller
Purchased
Amount
1
2
3
4
5
If additional space is necessary, attach a separate sheet with the same information
Net Untaxed Premium Cigar Purchases
6. Total invoice amount for all UNTAXED premium cigars purchased during this month . . . . . . . . . . . . .$
_________________
Tax Determination
X
.15
7. Tax Rate (15%) for premium cigars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
_________________
8. Maryland Other Tobacco Products (OTP) Tax Due (Multiply line 6 x line 7) . . . . . . . . . . . . . . . . . . . .$
_________________
Affidavit
I do solemnly declare and affirm under the penalties of perjury that the contents of this document are true, correct and complete to
the best of my knowledge, information and belief.
Print name
Title (Owner, Partner of Officer)
Signature
Date
COM/RAD 620
Revised 04/13
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