Maryland Form 609r - Otp Refund Claim Form For Wholesalers, Retailers, And Tobacconists
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1OTP REFUND CLAIM FORM FOR WHOLESALERS,
MARYLAND
Comptroller of Maryland
FORM
Revenue Administration Division
RETAILERS, AND TOBACCONISTS
609R
P.O. Box 2999
Annapolis, MD 21404-2999
This claim is subject to audit and possible adjustment.
Type of Refund (Check one):
CR# / License Number
Returned merchandise
Name (1)
Name (2)
Overpayment of OTP taxes
Address (1)
Other: _______________________
Address (2)
Period of Claim
City, State, ZIP code
From ____________ To ____________
Telephone Number
E-Mail Address
Part A For Returned Merchandise
REPORT MONTH _______________
Column A
Column D
Returned Merchandise on which
the tax has been paid (Use
Refund Amount
OTP Type
TIMES
Tax
EQUALS
rounded numbers)
PREMIUM CIGAR
X
.15
=
CIGAR
X
.70
=
OTHER
X
.30
=
TOTALS
Part B For Overpayment of OTP Taxes
Report Month
Amount of Overpayment
Refund Amount
TOTALS
CERTIFICATION: Under penalties of perjury, I declare that I have examined this return, and I hereby certify that all statements herein
made are true to the best of my knowledge and belief, and that no part of the refund herein claimed has been heretofore paid. I
further certify that the tax for which I am claiming refund has been paid by me.
Signed: __________________________________________________________
Date: ____________________________
COM/RAD-609R
(Rev 07/13)
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