Form 73a421 - 2009 Inventory Floor Tax For Cigarettes, Other Tobacco Products (Otp), And Snuff
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32009 INVENTORY FLOOR TAX FOR
73A421 (3/2009)
CIGARETTES, OTHER TOBACCO PRODUCTS (OTP),
Commonwealth of Kentucky
DEPARTMENT OF REVENUE
AND SNUFF
FOR INVENTORIES AS OF MARCH 31, 2009
TAX COMPUTATION AND FIRST PAYMENT INSTALLMENT REPORT
DO YOU SELL CIGARETTES?
YES
NO
Name and Address
—Complete Section 1 if yes.
DO YOU SELL OTHER TOBACCO
YES
NO
PRODUCTS (OTP)?
—Complete Section 2 if yes.
DO YOU SELL SNUFF?
YES
NO
—Complete Section 3 if yes.
IS THIS REPORT FOR MULTIPLE
YES
NO
04 / 09
LOCATIONS?
—Attach list of locations if yes.
Sales Tax Acct. No.
MM/YY
SECTION 1-CIGARETTE INVENTORY FLOOR TAX COMPUTATION
1. Number of Packs of 20 Cigarettes .................................................
2. Inventory Floor Tax Rate on 20’s .................................................. $
0.30
3. Tax due on 20’s (line 1 times line 2) ............................................ $
4. Number of Packs of 25 Cigarettes ................................................
5. Inventory Floor Tax Rate on 25’s ................................................. $
0.375
6. Tax Due on 25’s (line 4 times line 5) ............................................ $
7. AMOUNT DUE for Cigarettes (line 3 plus line 6) ...................... $
Enter on line 14
SECTION 2-OTHER TOBACCO PRODUCTS (OTP) INVENTORY FLOOR TAX COMPUTATION
8. Purchase Price of Inventory of OTP...............................................
9. Inventory Floor Tax Rate on OTP (7.5%) ........................................
0.075
10. AMOUNT DUE for OTP (line 8 times line 9) .............................. $
Enter on line 17
SECTION 3-SNUFF INVENTORY FLOOR TAX COMPUTATION
11. Number of Units of Snuff on hand ...............................................
12. Inventory Floor Tax Rate on Snuff ............................................... $
0.095
13. AMOUNT DUE for Snuff (line 11 times line 12) ........................ $
Enter on line 20
SECTION 4-INSTALLMENT PAYMENT COMPUTATION
14. Cigarette Inventory Floor Tax Due (line 7) .................................. $
016-07
15. Installment Payment 1 for Cigarettes (at least 1/3 of line 14) ..........................................................$
16. Remainder Due for Cigarettes (line 14 minus line 15) ............... $
17. OTP Inventory Floor Tax Due (line 10) ......................................... $
18. Installment Payment 1 for OTP (at least 1/3 of line 17) .................................................................... $
101-03
19. Remainder Due for OTP (line 17 minus line 18) ......................... $
20. Snuff Inventory Floor Tax Due (line 13) ....................................... $
21. Installment Payment 1 for Snuff (at least 1/3 of line 20) ................................................................. $
101-04
22. Remainder Due for Snuff (line 20 minus line 21) ....................... $
23. TOTAL DUE FOR INSTALLMENT 1 (line 15 plus line 18 plus line 21) .......................................................$
COMPLETE PAGE 2 IF LINE 16, 19, OR 22 IS NOT ZERO BEFORE SUBMITTING PAGE 1.
INSTALLMENT PAYMENT 1 IS DUE APRIL 10, 2009
Name
Date
Signature
Telephone Number/E-mail
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