OMB No. 1513-0094 (10/31/2011)
FOR TTB USE ONLY
DEPARTMENT OF THE TREASURY
Tax $
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Penalty $
FEDERAL FIREARMS AND AMMUNITION
Interest $
EXCISE TAX RETURN
Total $
(Please read the instructions before completing this form)
Examined by:
Date:
(Send us the original – keep a copy for your records)
Other
PART I - GENERAL
1.
My name, business name, and business location (number, street,
2. My daytime telephone is:
My E-mail address is:
city, state, and zip code)
3. My Employer Identification Number (EIN) is::
4. If this is a one-time or occasional return, check this box
If this is a final return, check this box
5. My form of payment (if any) is:
Note: You must make your check or money
order payable to the Alcohol and Tobacco Tax
Check
Money Order
and Trade Bureau and write your Employer
Identification Number (EIN) on your check or
EFT
Other (Specify)
.
money order. If you send a check, see paper
Check if above information has changed since you filed your last return
check conversion notice on reverse.
PART II – CALCULATION OF TAXES ON SALES OR USES DURING THIS TAX PERIOD
(Please refer to the appropriate instructions before completing Items 6 – 23)
6. My tax period begins
and ends on
/
/
/
/
(month, day, year)
(month, day, year)
Taxable Articles
(b)
For This Tax Period I Calculate My Taxes as Follows:
(a)
(c)
Other Firearms
Handguns
Ammunition
(Rifles, Shotguns,
(Pistols and Revolvers)
(Shells and Cartridges)
Machine Guns, etc.)
$
$
7. The sales price of all articles that I sold
$
8. The sales price of all articles that I sold tax-exempt or tax-free
When I make tax-free sales my tax-free registration number is:
9. My taxable sales (Line 7 minus Line 8)
10. Eligible adjustments
11. My adjusted taxable sales (Line 9 plus or minus Line 10)
12. The sales price of all articles I used
13. My total taxable sales and uses (Line 11 plus Line 12)
14. Tax rate
10%
11%
11%
15. My total tax (Multiply Line 13 by Line 14)
$
$
$
PART III – CALCULATION OF MY TAX LIABILITY FOR THIS TAX PERIOD
(Before making entries on Lines 17 - 23, complete Schedules A, B, and C on page 2 of this form)
16. My total of Lines 15 (a), (b), and (c)
$
17. My increasing adjustments from Line 33, Schedule B
$
18. My gross tax (Line 16 plus Line 17)
$
19. My decreasing adjustments from Line 39, Schedule C (Cannot be more than the amount on Line 18)
$
20. My net tax (Line 18 minus Line 19 . Must agree with Line 27, Schedule A. Cannot be less than zero)
$
21. My total deposits
$
If Line 21 is the same as Line 20 – STOP HERE – PROCEED TO LINE 40
If Line 20 is more than Line 21 – complete Line 22
If Line 21 is more than Line 20 – complete Line 23
22. Amount I need to pay with this return
$
23. I will apply this amount to my next return (Show in Schedule C, Line 37 of next return)
$
(If you are a one-time, occasional, or final filer, see Instruction 23)
TTB F 5300.26 (07/2009)
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