Form Atf F 5000.25 - Excise Tax Return - Alcohol And Tobacco (Puerto Rico)
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1
2OMB No. 1512-0497 (08/31/2002)
1. SERIAL NUMBER
DEPARTMENT OF THE TREASURY
BUREAU OF ALCOHOL, TOBACCO AND FIREARMS
EXCISE TAX RETURN - ALCOHOL AND TOBACCO (PUERTO RICO)
3. AMOUNT OF PAYMENT
(Prepare in duplicate - See instructions on back)
2. FORM OF PAYMENT
$
OTHER (Specify)
CHECK
MONEY ORDER
EFT
NOTE: PLEASE MAKE CHECKS OR MONEY
ORDERS PAYABLE TO THE BUREAU OF
4. RETURN COVERS (Check one)
BEGINNING
ALCOHOL, TOBACCO AND FIREARMS (SHOW
PREPAYMENT
PERIOD
EMPLOYER IDENTIFICATION NUMBER ON ALL
ENDING
CHECKS OR MONEY ORDERS)
5. DATE PRODUCTS TO BE REMOVED (For Prepayment Returns Only:)
FOR ATF USE ONLY
6. EMPLOYER IDENTIFICATION NUMBER
7. PLANT, REGISTRY, OR PERMIT NUMBER
$
TAX
PENALTY
8. NAME AND ADDRESS OF TAXPAYER (Include ZIP Code)
INTEREST
$
TOTAL
EXAMINED BY:
DATE EXAMINED:
CALCULATION OF TAX DUE (Before making entries on lines 18 - 21, complete Schedules A and B)
AMOUNT OF TAX
PRODUCT
(a)
(b)
9. DISTILLED SPIRITS
$
10. WINE
11. BEER
12. CIGARS
13. CIGARETTES
14. CIGARETTE PAPERS AND/OR CIGARETTE TUBES
15. CHEWING TOBACCO AND/OR SNUFF
16. PIPE TOBACCO AND/OR ROLL-YOUR-OWN TOBACCO
$
17. TOTAL TAX LIABILITY (Total of lines 9-16)
18. ADJUSTMENTS INCREASING AMOUNT DUE (From line 29)
19. GROSS AMOUNT DUE (Line 17 plus line 18)
$
20. ADJUSTMENTS DECREASING AMOUNT DUE (From line 34)
21. AMOUNT TO BE PAID WITH THIS RETURN (Line 19 minus line 20)
$
Under penalties of perjury I declare that I have examined this return (including any accompanying explanations, statements, schedules, and forms) and
to the best of my knowledge and belief it is true, correct, and includes all transactions and tax liabilities required by law or regulations to be reported.
22. DATE
23. SIGNATURE
24. TITLE
SCHEDULE A - ADJUSTMENTS INCREASING AMOUNT DUE
AMOUNT OF ADJUSTMENTS
EXPLANATION OF INDIVIDUAL ERRORS OR TRANSACTIONS
(a)
(b) TAX
(c) INTEREST
(d) PENALTY
$
$
$
25.
26.
27.
28. SUBTOTALS OF COLUMNS (b), (c) and (d)
$
$
$
29. TOTAL ADJUSTMENTS INCREASING AMOUNT DUE (Line 28, Col (b) + (c) + (d)) Enter here and on line 18.
$
SCHEDULE B - ADJUSTMENTS DECREASING AMOUNT DUE
AMOUNT OF ADJUSTMENTS
EXPLANATION OF INDIVIDUAL ERRORS OR TRANSACTIONS
(a)
(b) TAX
(c) INTEREST
$
$
30.
31.
32.
33. SUBTOTALS OF COLUMNS (b) and (c)
$
$
34. TOTAL ADJUSTMENTS DECREASING AMOUNT DUE (Line 33, Col (b) + (c)) Enter here and on line 20.
$
ATF F 5000.25 (02-2000) PREVIOUS EDITIONS ARE OBSOLETE
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