Dbpr Form Ab&t 4000a-305-1 - Out-Of-State Tobacco Products Distributor'S Report - Department Of Business And Professional Regulation - Florida

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DBPR Form AB&T
DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION
4000A-305-1
DIVISION OF ALCOHOLIC BEVERAGES AND TOBACCO
Rev. 12/03
1940 NORTH MONROE STREET • TALLAHASSEE FL 32399-1022
OUT-OF-STATE TOBACCO PRODUCTS DISTRIBUTOR'S REPORT
Prepare in TRIPLICATE. Submit ORIGINAL and FIRST COPY to the AUDITING OFFICE of the DIVISION OF ALCOHOLIC BEVERAGES AND
TOBACCO. SECOND COPY is to be retained by the licensee. This report and payment must be filed in accordance with the provisions of
Chapter 210, Florida Statutes, on or before the tenth day of the month following the month being reported. Make remittances payable to the
"Division of Alcoholic Beverages and Tobacco". Distributors paying $50,000 or more in excise taxes per year must remit tax payments
through electronic funds transfer, as prescribed by Chapter 210.31, Florida Statutes.
(
)
Permit No.
Permit Name
Phone No.
Address
City
State
Zip
Month Reported
Yr
Reporting Period
through
This report is true and correct to the best of my knowledge and belief and is submitted under penalty of perjury.
Typed or Printed Name
Authorized Signature
COMPUTATION OF TAX
1.
NET TAXABLE SALES (Total Wholesale Sales Price from page 2)
2.
EXCISE TAX at 25% of Wholesale sales price (Line 1 X .25)
3.
LESS:
1% COLLECTION ALLOWANCE (Line 2 X .01)
4.
NET AMOUNT TO BE REMITTED WITH THIS REPORT
5.
003053
DAB&T USE ONLY
REPORT RECEIPT
In'ls
PAYMENT VERIFICATION
In'ls
FIELD REVIEW
In'ls
CENTRAL PROCESSING
In'ls
Postmark Date
Receipt No.
Initial Review Date
Initial Receipt Date
Delivery Date
Payment Date
Amended Date
Completed Date
Delinquency Action
Excise Tax Paid
Amended Amount

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