Form M-19 - Cigarette And Tobacco Products Monthly Tax Return

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THIS SPACE FOR DATE RECEIVED STAMP
FORM
STATE OF HAWAII — DEPARTMENT OF TAXATION
CIGARETTE AND TOBACCO PRODUCTS
M-19
MONTHLY TAX RETURN
(REV. 2011)
Caution: Use Form M-19 (Rev. 2011) for sales, use, or possession of cigarettes and tobacco products after
June 30, 2011. For sales, use, or possession of cigarettes and tobacco products occurring after June 30,
2010, and before July 1, 2011, use Form M-19 (Rev. 2010).
MCF111
Amended Return (Attach Sch AMD)
Change in Name or Address
Check if
Name
Month Ending
__ __ / __ __
(MM/YY)
DBA or C/O
Cigarette Tax and Tobacco Tax
License Number
Address (Number and Street)
Hawaii Tax I.D. No.
W
___ ___ ___ ___ ___ ___ ___ ___ - ___ ___
City or town, State, and Postal/ZIP Code. If foreign address, see Instructions.
Federal Employer I.D. No./Social Security No.
Contact Name
Telephone Number
TOBACCO PRODUCTS
1.
Wholesale sales for the month ..................................................................................................................................
1
2.
Retail sales for the month ..........................................................................................................................................
2
3.
Taxable use of tobacco products ...............................................................................................................................
3
4.
Total tobacco products (add lines 1, 2, and 3) ...........................................................................................................
4
5.
Less non-taxable sales (from page 2, Part I, Non-Taxable Sales of Tobacco Products) ...........................................
5
6.
Total taxable tobacco products (line 4 minus line 5) ..................................................................................................
6
7.
Tobacco tax on tobacco products (multiply line 6 by 70%) ........................................................................................
7
LARGE CIGARS
8.
Wholesale sales for the month ..................................................................................................................................
8
9.
Retail sales for the month ..........................................................................................................................................
9
10. Taxable use of large cigars ........................................................................................................................................
10
11. Total large cigars (add lines 8, 9, and 10)..................................................................................................................
11
12. Less non-taxable sales (from page 2, Part I, Non-Taxable Sales of Large Cigars) ...................................................
12
13. Total taxable large cigars (line 11 minus line 12) .......................................................................................................
13
14. Tobacco tax on large cigars (multiply line 13 by 50%) ...............................................................................................
14
LITTLE CIGARS
Total Wholesale Value
15. Number of little cigars sold at wholesale during the month ...........................................
$
15
16. Number of little cigars sold at retail during the month ...................................................
$
16
17. Number of little cigars used during the month subject to the tax ...................................
$
17
18. Total number of little cigars sold and used during the month (add lines 15, 16, and 17)...........................................
18
19. Less non-taxable sales (Number of little cigars from page 2, Part I, Non-Taxable Sales of Little Cigars) .................
19
20. Total taxable little cigars (line 18 minus line 19) ........................................................................................................
20
21. Tobacco tax on little cigars (multiply line 20 by $.16 ) ...............................................................................................
21
22. Total Tobacco Tax (add lines 7, 14, and 21)...............................................................................................................
22
23. Refund of cigarette tax paid with cigarette tax stamps (from page 4, Part II, line 6) .................................................
23
24. Total Tobacco Tax Due (line 22 minus line 23) ...........................................................................................................
24
25. Penalty (5% per month to a maximum of 25%) .........................................................................................................
25
26. Interest (2/3 of 1% per month to a maximum of 8% per annum) ...............................................................................
26
27. Total Amount Due With Return (add lines 24, 25, and 26) ........................................................................................
27
28. AMENDED RETURN ONLY – Amount paid (overpaid) on original return. (See Instructions) ..................................
28
29. AMENDED RETURN ONLY – Balance due (refund) with amended return. (See Instructions) ................................
29
30. Amount of Your Payment ...........................................................................................................................................
30
DECLARATION: I declare, under the penalties set forth in section 231-36, HRS, that this is a true, correct, and complete return, prepared in accordance
with the provisions of chapter 245, HRS, the Cigarette Tax and Tobacco Tax Law, and chapter 18-245, HAR.
Signature
Title
Print name of signatory
Date
FORM M-19

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