Form Cg-47 - Schedule D Request For Refund For Stamped Unsaleable Cigarettes Returned To Manufacturer

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KANSAS DEPARTMENT OF REVENUE
MISCELLANEOUS TAX – CUSTOMER RELATIONS
915 SW HARRISON ST.
TOPEKA, KANSAS 66612-1588
Web site:
Email: miscellaneous.tax@kdor.ks.gov
Phone: (785) 368-8222
Fax: (785) 291-3968
SCHEDULE D
REQUEST FOR REFUND FOR STAMPED UNSALEABLE CIGARETTES RETURNED TO
MANUFACTURER
The undersigned states that these stamped unsaleable cigarettes were returned by
(Name of Wholesaler)
to the Manufacturer, and that all packages of cigarettes
(Address of Wholesaler)
had Kansas indicia affixed.
Less .80%
Number of Packs
Tax Rate
Gross Tax Amount
Wholesaler Discount
Net Tax Paid
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
0.00
11. Grand total of tax paid (add lines 1 through 10)
0.00
12. Less: .80% Processing Fee
0.00
13. Net refund (line 11 minus line 12)
states, as supported by their affidavit dated
(Manufacturer)
, that these cigarettes will not be reshipped into Kansas and that the indicia
affixed thereto has been destroyed.
(Signature of Wholesaler)
CG-47
(Rev. 6/13)

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