Form Com/att-603 - Wholesaler'S Claim For Credit - Cigarette Tax Stamps
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1
2Comptroller of Maryland
MATT Regulatory Division
Alcohol and Tobacco Tax
P.O. Box 2999
Annapolis, Maryland 21404-2999
Wholesaler’s Claim for Credit - Cigarette Tax Stamps
(See reverse for instructions.)
Name:
Date:
Address:
License No:
Application is hereby made for credit on cigarette stamps as indicated below:
Quantity
Value @ $2.00/Stamp
Less .82% Discount
Net Credit
$
$
$
Quantity
Value @ $2.50/Stamp
Less .82% Discount
Net Credit
$
$
$
Total Quantity
Total Stamp Value
Total Discount
Total Net Credit
$
$
$
Credit is requested for the reason(s) checked:
Quantity
Reason for Credit Claim
9
Stamps mutilated.
9
Stamped cigarettes unsalable and returned to manufacturer.
9
Stamps on carton flaps.
9
Multiple stamps cancelled by Comptroller’s Office
representative.
9
Licensee discontinued the affixing of tax stamps. (May qualify
for cash refund - see back)
I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing
document are true and correct to the best of my knowledge, information and belief.
Print Name
Signature
Title: Owner, Partner or Officer
Date
Submit in triplicate (original plus 2 copies).
FOR USE BY ATT ONLY
Stamps received by:
Date:
Received via:
Date:
Approved for issue by:
Date:
Issued by:
Credit No.
Date:
COM/ATT-603
Revised 11/07
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