2013
MARYLAND OTHER TOBACCO
fORM
610C
PRODUCTS (OTP) TAX RETURN -
SCHEDULE C - OTP TAX CREDiT -
OUT Of STATE SALES
CHECK ONE:
RETAILER
TOBACCONIST
Legal Name
FEIN
Office Use Only
Check Number __________
Trade Name
Amount $ _____________
Deposit Date____________
Street Address
For Calendar Quarter:
January - March
City
State
ZIP code
April - June
Central Registration Number (CR#)
July - September
October - December
Completed by OTP Retailer and OTP Tobacconist
1a.
Total net invoice amount for all untaxed "premium cigars" reported on line 1a of the OTP tax
return, Form 610, that was sold out-of-state during the reporting quarter . . . . . . . . . . . . . . 1a. _____________________
x 0.15
b.
OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. _____________________
$
c.
Maryland OTP credit (multiply line 1a by line 1b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. _____________________
2a.
Total net invoice amount for all untaxed "pipe tobacco" reported on line 2aof the OTP tax
return, Form 610, that was sold out-of-state during the reporting quarter . . . . . . . . . . . . . . 2a. _____________________
x 0.30
b.
OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. _____________________
$
c.
Maryland OTP credit (multiply line 2a by line 2b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. _____________________
$
3.
Total Maryland OTP credit (add lines 1c and 2c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. _____________________
Completed by OTP Tobacconist Only
4a.
Total net invoice amount for all untaxed cigars (other than premium cigars) reported on line
4a of the OTP tax return, Form 610, that was sold out-of-state during the reporting quarter . .4a. _____________________
x 0.70
b.
OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. _____________________
$
c.
Maryland OTP credit (multiply lines 4a by 4b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. _____________________
5a.
Total net invoice amount for all untaxed "other tobacco products" (OTP) reported on line 5a
of the OTP tax return, Form 610, that was sold out-of-state during the reporting quarter . . . 5a. _____________________
x 0.30
b.
OTP tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. _____________________
$
c.
OTP Tax due (multiply lines 5a by 5b) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . c. _____________________
$
6.
Total Maryland OTP credit (add lines 4c and 5c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6. _____________________
Completed by OTP Retailer or Tobacconist
$
7.
Total Maryland OTP credit (add lines 3 and 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. _____________________
Enter total amount of the Maryland OTP credit on line 7 on the OTP tax return, Form 610, line 7. Please attach a report
with the following information about out-of-state sales: date of sale, invoice number, to whom sold, and invoice amount.
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
Date
COM/RAD-610-3
Revised 02/13