Order For State-Administered County Revenue Stamps - Alabama Department Of Revenue
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1TOB: CoSO
5/12
A
D
R
For Office Use Only
LABAMA
EPARTMENT OF
EVENUE
EFT: _____________________
B
& L
T
D
USINESS
ICENSE
AX
IVISION
Order Received By: _________
Reset
Date Received: _____________
T
T
S
OBACCO
AX
ECTION
Processed By: ______________
P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627
Date Processed: _____________
Order For State-Administered County Revenue Stamps
NAME (PERSON, FIRM, OR CORPORATION)
PERMIT / REGISTRATION NUMBER
ADDRESS
FEIN OR SOCIAL SECURITY NUMBER
CITY
STATE
ZIP
TELEPHONE NUMBER
–
(
)
METHOD OF SHIPMENT
CONTACT PERSON
Bus
Pick Up
Federal Express –
Overnight
Two Days
Federal Express Account No.
COUNTY CIGARETTE REVENUE STAMPS
CONVERT
NO. OF
*7-1/2%
COUNTY
NO. OF
TAX
VALUE OF STAMPS
NET
COUNTY
ROLLS TO
HAND APPLIED
DISCOUNT
CODE
ROLLS
RATE
ORDERED
AMOUNT DUE
NO. OF STAMPS
STAMPS
(IF APPLICABLE)
06010
Barbour
$ 0.10
$
$
$
09005
Bullock
$ 0.05
12025
Chambers
$ 0.25
13009
Cherokee
$ 0.09
17025
Clay
$ 0.25
22005
Coosa
$ 0.05
24005
Crenshaw
$ 0.05
33005
Franklin
$ 0.05
34005
Geneva
$ 0.05
37005
Henry
$ 0.05
38005
Houston
$ 0.05
44005
Limestone
$ 0.05
49004
Marion
$ 0.04
02005
Mobile
$ 0.05
56025
Randolph
$ 0.25
61005
Talladega
$ 0.05
65011
Washington
$ 0.11
$
$
$
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$
Total Net Amount Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Check here if amount remitted via Electronic Funds Transfer (EFT)
Print
Stamps: County stamps are available in rolls of 15,000 which are machine applied, and sheets of 100 applied by use of a hand iron. Stamps must be
purchased in full roll and full sheet quantities.
Purchases: County stamp purchases may be made with cash, certified funds (cashier’s check, money order, etc.) or Electronic Funds Transfer (EFT).
Payments of $750 or greater are required to be made electronically via EFT. You may choose to make payments by EFT if the amount is less than $750.
All purchases will be on the cash basis, no consignment orders. Stamp shipments will be made according to the taxpayer’s chosen method of
shipment. An order form MUST be completed by the taxpayer and mailed or FAXED (334/353-1011) to the Department.
*Discount: A 7-1/2% discount is allowed on stamp purchases made by qualified wholesalers with a tobacco stamping permit ONLY. Insufficient
payments will result in loss of the discount and penalty and interest charges will be applied.
DO NOT combine state stamp payments and playing cards stamp payments with county stamp payments.
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