Ets Form 140 - Cigarette Wholesaler Monthly Report - Wyoming Department Of Revenue
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1Wyoming Department of Revenue
Cigarette Wholesaler’s Monthly Report
th
122 West 25
Street (Herschler Building)
Cheyenne, WY 82002-0110
License Number:______________________
Report Period:________________________
Company Name:____________________________________________________________________________
Mailing Address:____________________________
Location Address:___________________________
City:______________________________ State:_________
Zip:__________________
Stamp Reconciliation:
Stamps
1.
Beginning unaffixed stamp inventory
__________________
2.
Beginning stamped package inventory
__________________
3.
Stamps Purchased during the month
__________________
4.
Total Stamps available for use (Lines 1 + 2 + 3)
__________________
5.
Deductions:
a.
Stamped product returned to manufacturer for credit
__________________
b.
Stamps spoiled and returned to Department for credit
__________________
c.
Unaccountable Stamps
__________________
d.
Ending inventory – unaffixed stamps
__________________
e.
Ending inventory – stamped packages
__________________
6.
Total Deductions (Lines 5a + 5b +5c +5d +5e)
__________________
7.
Total stamped packs sold/delivered during the month (Line 4 – Line 6)
__________________
Cigarette Sales (Packages)
Packages (20)
Packages (25)
1.
Total stamped packs sold/delivered in WY during the month
______________
____________
Totals will equal total of Section II on attached pages
2.
Packs sold on Wind River Reservation – Unstamped product
______________
____________
Calculation of Cigarette Taxes Due:
1.
Enter the grand total of 25-Cigarette packages sold during the month
__________________
2.
Multiplication factor (14.10 cents per package)
_______0.1410_____
3.
Tax due on 25-Cigarette packages sold during the month
__________________
I declare, under penalty of perjury, that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief it is correct and complete.
Signed:___________________________________________
Title:_______________________________
Printed Name:______________________________ Telephone:__________________
Date:_____________
ETS Form 140 Revised 5/12/08
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