OMB No. 1513-0094
FOR TTB USE ONLY
DEPARTMENT OF THE TREASURY
Examined by:
ALCOHOL AND TOBACCO TAX AND TRADE BUREAU
Tax $
FEDERAL FIREARMS AND AMMUNITION
Other:
Penalty $
QUARTERLY EXCISE TAX RETURN
Interest $
(Please read the instructions before completing this form)
(Send us the original – keep a copy for your records)
Date:
Total $
PART I - GENERAL
1. Business name and location
3. Employer Identification Number (EIN)
4. Daytime telephone number
(number, street, city, state, and zip code)
5. Form of payment
6.
Type of return
(if any)
(Check all that apply )
Check
Other (Specify)
Quarterly
Annual
One-time/Occasional
EFT
Final
Amended
Money Order
Note: Make your check or money order payable to the Alcohol & Tobacco Tax & Trade
Bureau, and write your Employer Identification Number (EIN) on your check or money order.
If you send a check, see the paper check conversion notice on page 2.
Address changed since last return was filed
2. E-mail address
7. Tax period
(Enter the year and select only one quarterly period)
Year
July 1 - September 30
January 1 - March 31
October 1 - December 31
April 1 - June 30
PART II – CALCULATION OF TAXES ON SALES OR USES DURING THIS TAX
PERIOD
(Please refer to the appropriate instructions before completing Items 8 – 22)
Taxable Articles
Other Firearms
Handguns
Ammunition
(Rifles, Shotguns,
Taxes Calculated for This Tax Period
(Pistols and Revolvers)
(Shells and Cartridges)
Machine Guns, etc.)
(a)
(b)
(c)
8. The sales price of all articles sold
$
$
$
9. The sales price of all articles sold tax-exempt
10. The sales price of all articles sold tax-free
TTB Tax-free Registration Number:
11. Taxable sales
(Item 8 minus Item 9 and Item 10)
12. Eligible adjustments
13. Adjusted taxable sales
(Item 11 plus or minus Item 12)
14. The sales price of all articles used
15. Total taxable sales and uses
(Item 13 plus Item 14)
Tax Rates
10%
11%
11%
16. Total tax
$
$
$
(Multiply Item 15 by the Tax Rate above)
PART III – CALCULATION OF TAX LIABILITY FOR THIS TAX PERIOD
(Before making entries on Lines 18 - 22, complete Schedules A and B on page 2 of this form)
17. Total of Items 16(a) + 16(b) + 16(c)
$
18. Increasing adjustments from Item 27, Schedule A
19. Gross tax
(Item 17 plus Item 18)
20. Decreasing adjustments from Item 34, Schedule B
(Cannot be more than the amount on Item 19)
21. Net tax due with this return
(Item 19 minus Item 20 . Cannot be less than zero)
$
22. Amount paid with this return
TTB F 5300.26 (12/2014)
Previous editions are obsolete
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