Form B-A-5 - Monthly Return Of Resident Cigarette Distributor

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B-A-5
Monthly Return of Resident Cigarette Distributor
Web
North Carolina Department of Revenue
8-12
DOR Use Only
Application
Beginning
Ending
for Period
(mm-DD-YY)
(mm-DD-YY)
Legal Name (First 35 Characters) (USE CAPITAL LETTERS FoR YoUR nAmE AnD ADDRESS)
FEIN or SSN
Trade Name
Mailing Address
NCDOR ID/License Number
State
City
Zip Code
State of Domicile
Name of Contact Person
Fill in circle if applicable:
Phone Number
Fax Number
Amended Return
Schedule A. Non-Tax-Paid Cigarette Inventory and Computation of North Carolina Cigarette Excise Tax
Packs of Non-Tax-Paid Cigarettes
Column A
Column B
List in Packs of:
(ImPoRTAnT : non-TAx-PAID, whenever used in this return, including the Schedule I
and Schedule J attachments, means “no north Carolina cigarette tax paid.”)
Twenty
Twenty-Five
,
,
,
,
1. Non-Tax-Paid Packs Beginning Inventory
1.
,
,
,
,
2. Purchased and Received From Manufacturer
2.
(From Page 3, Schedule C, Total)
,
,
,
,
3. Other Increases in Inventory
3.
(Attach an explanation)
,
,
,
,
4. Add Lines 1 through 3
4.
5. Sold to Federal Government and Its
,
,
,
,
5.
Instrumentalities
(From Page 2, Schedule B, Total)
6. Shipped, Delivered, or Sold Outside North
,
,
,
,
6.
Carolina
(From Form B-A-5, Schedule I, attached)
7. Non-Tax-Paid Packs Returned to Manufacturer
,
,
,
,
7.
(From Form B-A-5, Schedule J, attached)
,
,
,
,
8. Other Decreases in Inventory
8.
(Attach an explanation)
,
,
,
,
9. Non-Tax-Paid Packs Ending Inventory
9.
(Actual Physical Inventory)
,
,
,
,
10. Total Deductions
(Add Lines 5 through 9)
10.
11. Total Packs Subject to North Carolina Tax
,
,
,
,
Line 4 minus Line 10 (Note: If paying on total purchases
11.
rather than sales, carry total to Page 4, Schedule D, Line 3.)
12. Tax Rate: 2.25¢ per Cigarette
12.
45¢
56.25¢
(Pack of 20, Rate 45¢; Pack of 25, Rate 56.25¢)
,
,
,
,
.
.
13. Total Excise Tax Due
13.
(Multiply Line 11 by Line 12)
00
00
,
,
.
14. Total Tax
(Add Column A and Column B on Line 13)
14.
00
15. Discount
,
,
.
Multiply Line 14 by 2% if report with full payment is
15.
00
timely filed; otherwise enter zero.
,
,
.
16. Net Excise Tax Due
16.
(Line 14 minus Line 15)
00
,
,
.
(10% for late payment; 5% per month, maximum 25%, for late filing)
17. Penalty
17.
00
Multiply Line 14 by rate above if return with full payment is not filed timely.
,
,
.
18. Interest
(See the Department’s website, , for current interest rate.)
18.
00
Multiply Line 14 by applicable rate if return with full payment is not filed timely.
,
,
.
$
19. Total Payment Due
19.
(Add Lines 16 through 18)
00
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
For your convenience, electronic payment methods are available through our website at .
Returns are due within twenty days after the end of each month. Form B-A-7, Tobacco Return Tax-Paid Products of Nonparticipating
Manufacturers, must be filed with this return. Mail this form with your check or money order in U.S. currency from a domestic bank to:
North Carolina Department of Revenue, PO Box 25000, Raleigh, North Carolina 27640-0110

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