Form Wv/otp-7o1 - Tobacco Products Tax Report - 2001
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1WV/OTP-7O1
This report is due on or
th
REV. 7-01
before the 15
day of each
WEST VIRGINIA STATE TAX DEPARTMENT
month reflecting transactions
from the preceding month,
TOBACCO PRODUCTS TAX REPORT
even if no business was
conducted
)
(DOES NOT INCLUDE CIGARETTES
West Virginia Identification Number, Name and Address
Report Period:
Due Date:
1.
Total gross invoice price of sales/use in West Virginia
(you must have copies of invoices available upon
COMPLETE SCHEDULE A FOR “ROLL YOUR OWN” FOR NON-
request, etc. to verify this figure) -
$
PARTICIPATING MANUFACTURERS BRANDS ONLY
Credits:
a. Total gross invoice price of returns for credit
$_____________
b. Less 4% discount
$_____________
(line a X 4%, allowed when tax originally remitted)
c. Less 5% statutory discount
$_____________
(line a X 5%)
2.
Total credit (line a less lines b and c)
$
3.
Total gross invoice price (line 1 less line 2)
$
4.
GROSS TAX DUE
$
(Line 3 x 7%)
5.
DISCOUNT
$
(Line 4 X 4%)
6.
NET TAX DUE (LINE 4 less line 5) -
AMOUNT MUST BE REMITTED WITH THIS
$
REPORT
______________________________,
I,
DECLARE UNDER PENALTY OF PERJURY THAT THIS REPORT, INCLUDING ANY
ACCOMPANYING SCHEDULES AND STATEMENTS, HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND
BELIEF IS A TRUE, CORRECT AND COMPLETE REPORT.
_______________
______________________________________,
__________________
DATE:
SIGNATURE:
TITLE:
(____) ____-_________
TELEPHONE NUMBER WHERE YOU CAN BE REACHED DURING BUSINESS HOURS
YOU MUST KEEP A COPY OF THIS REPORT AND SCHEDULES FOR YOUR RECORDS
FOR INSTRUCTIONS AND/OR INFORMATION, CONTACT:
WEST VIRGINIA STATE TAX DEPARTMENT
P. O. BOX 2991
CHARLESTON, WEST VIRGINIA 25330-2991
(304) 558-8500
DO NOT USE SPACE BELOW
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