Form 73a421 - Cigarette Inventory Floor Tax

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73A421 (5/2005)
CIGARETTE
1
Commonwealth of Kentucky
INVENTORY FLOOR TAX
Department of Revenue
FOR INVENTORIES AS OF MAY 31, 2005
Due June 10, 2005
Name and address
DO YOU SELL CIGARETTES
____ NO ____ YES
1. Number of Packs of 20 cigarettes
.27
2. Inventory Floor Tax Rate on 20 s
3. Tax due on 20 s (line 1 times line 2)
4. Number of Packs of 25 cigarettes
.3375
5. Inventory Floor Tax Rate on 25 s
/016/05/05/05
6. Tax due on 25 s (line 4 times line 5)
TT MM YY TR
SALES TAX ACCT NO
7. AMOUNT DUE (line 3 plus line 6)
/
8. ONE-TIME PAYMENT (line 7)
Signature
Title
-or-
9. INSTALLMENT PAYMENT
Date
(One-third of line 7)(See Instructions)
73A421 (5/2005)
CIGARETTE
2
Commonwealth of Kentucky
INVENTORY FLOOR TAX
Department of Revenue
FOR INVENTORIES AS OF MAY 31, 2005
Due July 10, 2005
Name and address
1. Line 7 from Installment 1
2. Amount paid with Installment 1
3. Remaining Balance Due
(subtract line 2 from line 1)
4. Installment 2 (one-half of line 3)
/016/05/05/05
/
TT MM YY TR
SALES TAX ACCT NO
Title
Signature
Date
73A421 (5/2005)
CIGARETTE
3
Commonwealth of Kentucky
INVENTORY FLOOR TAX
Department of Revenue
FOR INVENTORIES AS OF MAY 31, 2005
Due August 10, 2005
Name and address
1. Line 7 from Installment 1
2. Amount paid with Installments 1 and 2
3. Installment 3 Amount Due
(subtract line 2 from line 1)
/016/05/05/05
/
TT MM YY TR
SALES TAX ACCT NO
Title
Signature
Date

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Parent category: Financial
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