Form Cig 50016 - Oklahoma Tax Commission Consumer Cigarette Tax Return

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CIG 50016
Revised 9-2011
Oklahoma Tax Commission
Consumer Cigarette Tax Return
Oklahoma Tax Commission
2501 North Lincoln Boulevard
Oklahoma City, OK 73194
Cigarette Tax is due on the 10th day of the month following date of purchase.
______________________________________________________________
___________________________________________
Consumer’s Name
Reporting Period
______________________________________________________________
___________________________________________
Address
Contact Telephone Number
______________________________________________________________
City
State
Zip
Number of
Tax Due This Purchase
Seller’s
Seller’s Web Address
Transaction
Invoice
Brand Name of
Cigarette Cartons
= Number of Cartons
Name
when Applicable
Date
Number
Cigarettes Purchased
Purchased
X $10.30
Total Cigarette Tax Due
Interest
(Interest is 15% annually - 1-1/4% monthly beginning the day after the due date)
Penalty
(Penalty is 10% of the tax amount, once it becomes 30 days delinquent)
Total
I, the undersigned do declare under the penalties of perjury that this report, including the accompanying schedules which are made a part hereof, is to the
best of my knowledge and belief true and correct.
Signature
Date
Instructions
Complete consumers information as requested.
Complete seller’s information as requested and attach copy of purchase invoice.
Calculate tax due on each entry.
Total all cigarette taxes due.
Attach remittance for total due and mail to the address below:
Oklahoma Tax Commission
2501 North Lincoln Boulevard
Oklahoma City, OK 73194

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