Form R-5629 - Consumer Excise Tax Return
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2R-5629 (8/05)
Social Security Number
Consumer Excise Tax Return
Name
Taxpayer Services Division
Excise Taxes Section
Address
P.O. Box 201
City
State
ZIP
Baton Rouge, LA 70821-0201
(225) 219-7656
Taxable Period
(225) 219-2114 (TDD)
CONSUMER EXCISE TAX RETURN
Mail this return and payment to the address listed above.
Consumer Excise Tax Notice to Taxpayers
Louisiana Alcoholic Beverage and Tobacco Tax laws levy an excise tax on all alcoholic beverages and tobacco products sold or consumed in
Louisiana. If you purchased alcohol or tobacco products for personal consumption from out-of-state companies via such means as mail order,
catalogs, or the Internet, and were not properly charged Louisiana excise taxes, you are required to file and pay the tax directly to the Department of
Revenue. Use the form below to report any taxable purchases made from companies that did not collect Louisiana excise taxes.
A
B
C
D
E
F
Schedule A
Sparkling
Wine and
Still Wine
Still Wine
Still Wine
between
not more
Alcoholic Beverages
Beer and
more than
14% and
than 14%
Malt
24% alcohol
24% alcohol
alcohol by
Beverages
Liquor
by volume
by volume
volume
(Ounces)
(Liters)
(Liters)
(Liters)
(Liters)
Total
1. Total ounces or liters purchased
2. Amount subject to tax
(Divide Line 1 by 3,968.)
$10
$ .66
$ .42
$ .06
$ .03
3. Tax rate
4. Tax (See instructions.)
5. Parish/Municipality Tax
(Multiply Line 2 by $1.50.)
6. Amount due (Add Lines 4 and 5.)
7. Total alcoholic beverages tax (Add Line
6 of Columns A through E.)
A
B
C
D
E
F
Schedule B
Cigars
Cigars
Tobacco Products
(invoiced at
(invoiced at
$.12 or less
over $.12
Smoking
Smokeless
Cigarettes
per cigar)
per cigar)
Tobacco
Tobacco
Total
1. Cigarettes – number of sticks purchased
2. Invoice price of other tobacco products
3. Tax rate
$.018
.08
.20
.33
.20
4. Tax (Multiply Line 1 or Line 2 by Line 3.)
5. Total tobacco products tax
(Add Line 4 of Columns A through E.)
Total tax due (Add Schedule A, Line 7F and Schedule B, Line 5F.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
DO NOT SEND CASH.
Mail this return to P.O. Box 201, Baton Rouge, LA 70821-0201.
Under the penalties of perjury, I declare that I have examined this return, including all accompanying documents, and to the best of my knowledge and
belief, it is true, correct, and complete.
____________________________________
____________
Signature
Date
6670
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