Form 609 - Maryland Other Tobacco Products (Otp) Wholesaler Tax Return - 2013

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2013

MARylAnD OTHeR TOBAccO PRODUcTs

fORM

609

(OTP) WHOlesAleR TAX ReTURn

Legal Name

FEIN

Office Use Only

Trade Name

Check Number __________

Street Address

Amount $ _____________

City

State

ZIP code

Central Registration Number (CR#)

Report Month

Deposit Date____________

Sales to Maryland OTP Retailers or Tobacconists During the Report Month

Product Type

Number of Sales

Total Wholesale Price

1a. Premium Cigars . . . . . . . . . . . . . . . . . . ___________________________

$ __________________________

b. OTP Tax Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X 0.15

c. Total Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ __________________________

2a. Cigars . . . . . . . . . . . . . . . . . . . . . . . . ___________________________

$ __________________________

b. OTP Tax Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X 0.70

c. Total Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ __________________________

3a. Roll-Your-Own (RYO) Tobacco . . . . . . . . ___________________________

$ __________________________

b. Pipe Tobacco . . . . . . . . . . . . . . . . . . . . ___________________________

$ __________________________

c. Chewing Tobacco . . . . . . . . . . . . . . . . . ___________________________

$ __________________________

d. Snuff . . . . . . . . . . . . . . . . . . . . . . . . . ___________________________

$ __________________________

e. Other . . . . . . . . . . . . . . . . . . . . . . . . . ___________________________

$ __________________________

f. Subtotal (add lines 3a to 3e) . . . . . . . . . ___________________________

$ __________________________

g. OTP Tax Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

X 0.30

h. Total Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ __________________________

4. Total OTP Tax Due (add Column C, lines 1c, 2c, and 3h) . . . . . . . . . . . . . . . . . . . . . . . .$ __________________________

scHeDUle A (FORM 609A) - COMPLETE AND ATTACH FOR ALL ROLL-YOUR-OWN (RYO) TOBACCO SOLD DURING REPORT MONTH

Affidavit

I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing documents 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-609

Revised 02/13