Form 610 - Maryland Other Tobacco Products (Otp) Tax Return - 2013

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2013

MARYLAND OTHER TOBACCO

FORM

610

PRODUCTS (OTP) TAX RETURN

CHECK ONE:

RETAILER

TOBACCONIST

Legal Name

FEIN

Office Use Only

Check Number __________

Trade Name

Amount $ _____________

Deposit Date____________

Street Address

For Calendar Quarter:

City

State

ZIP code

January - March

April - June

Central Registration Number (CR#)

Report Quarter

July - September

October - December

Completed by OTP Retailer and OTP Tobacconist

1a. Total net invoice amount for all untaxed “premium cigars” purchased during the report quarter . . . ____________________

b. OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 0.15

c. OTP tax due (multiply line 1a by line 1b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________

2a. Total net invoice amount for all untaxed “pipe tobacco” purchased during the report quarter . . . . . ____________________

b. OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 0.30

c. OTP tax due (multiply line 2a by line 2b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________

3. Total OTP tax due, before credit (add lines 1c and 2c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________

Completed by OTP Tobacconist Only

4a. Total net invoice amount for all untaxed cigars (other than premium cigars) purchased during

the report quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________________

b. OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 0.70

c. OTP tax due (multiply lines 4a by 4b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________

5a. Total net invoice amount for all untaxed “other tobacco products” (OTP) purchased during

the report quarter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ____________________

b. OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X 0.30

c. OTP Tax due (multiply lines 5a by 5b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________

6. Total OTP tax due, before credit (add lines 4c and 5c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________

Completed by OTP Retailer or Tobacconist

7. OTP Tax Credit (complete Schedule 610C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ____________________

8. Net OTP tax due. (For OTP Retailers, enter the result of line 3 minus line 7.)

(For OTP Tobacconist, enter the result of line 3 plus line 6, minus line 7.) . . . . . . . . . . . . . . . . . $ ____________________

Affidavit

I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document are true, correct and

complete to the best of my knowledge, information and belief.

Print name

Title (Owner, Partner or Officer)

Signature