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MONTANA
                                                                                                                                                TP-103
                                                                                                                                                Rev 7-05


               Tobacco Product Tax Credit for Returned Products
Business Name                                                                        License No.                    Date


Principal or Agent Name                                                                                             Phone


Address                                                                                                             Fax


City                                                                                 State                          Zip



                                                 Instruction for form preparation
1. Prepare in duplicate. Submit the original to Montana Department of Revenue, Customer Intake Process, P.O. Box
   1712, Helena, MT 59604-1712. Retain a duplicate in company file for field audit purposes.
2. Credit claimed on schedule A for merchandise returned to a manufacturer or destroyed due to age, damage in transit,
   etc., must be substantiated with copies of all credit memos from the manufacturer or an affidavit signed by the
   principal manager or owner.



Section 1 –Tobacco product tax credit reconciliation

          1. Total tobacco products tax from manufacture credit memos
             (total line 3, column A, schedule A) ............................................................ $ ___________________

          2. Total moist snuff products tax from manufacture credit memos
             (total line 3, column B, schedule A) ........................................................... $ ___________________

          3. Total add line 1 and line 2 ........................................................................... $ ___________________

          4. Discount rate................................................................................................     0.015 (1.5%)

          5. Total tobacco product tax discount (multiply line 3 by line 4) ..................... $ ___________________

          6. Tobacco product tax credit (subtract line 5 from line 3) .............................. $ ___________________




          I hereby swear and affirm under penalty of false swearing that the information herein and attachments are true
          and correct to the best of my knowledge.




          Print Name of Principal or Agent                                               Date                                Signature of Principal or Agent




                                                                                                                                                         360
Schedule A – Tobacco products returned to manufacturer or destroyed
For the period of ___________________________________________

Business name ____________________________________________ Phone _________________________

                                         Manufacturer                                                                                                          Value of other       Weight of moist
                                                                                                                                                             tobacco products       snuff on memo
                                                                                                                    Date of          Credit memo                 on memo                  (oz)
                                                                                                                    memo                  ID                                              (B)
                                                                                                                                                                    (A)
        Name                                       Address                                   Phone

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

                                                                                                                                                             $                                      oz

          1. Total manufacturer refund credit value................................................................................................ $                                               oz

          2. Tobacco products tax rates...................................................................................................................       0.50 (50%)            $0.85 / oz
          3. Total manufacturer refund credit tobacco products tax (multiply line 1 with line 2)
             Total value of column A on line 1, section 1, and column B on line 2, section 1 ............................ $                                                     $


                                                                                                                                                                                                    360

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gov revenue formsandresources forms TP103

  • 1. MONTANA TP-103 Rev 7-05 Tobacco Product Tax Credit for Returned Products Business Name License No. Date Principal or Agent Name Phone Address Fax City State Zip Instruction for form preparation 1. Prepare in duplicate. Submit the original to Montana Department of Revenue, Customer Intake Process, P.O. Box 1712, Helena, MT 59604-1712. Retain a duplicate in company file for field audit purposes. 2. Credit claimed on schedule A for merchandise returned to a manufacturer or destroyed due to age, damage in transit, etc., must be substantiated with copies of all credit memos from the manufacturer or an affidavit signed by the principal manager or owner. Section 1 –Tobacco product tax credit reconciliation 1. Total tobacco products tax from manufacture credit memos (total line 3, column A, schedule A) ............................................................ $ ___________________ 2. Total moist snuff products tax from manufacture credit memos (total line 3, column B, schedule A) ........................................................... $ ___________________ 3. Total add line 1 and line 2 ........................................................................... $ ___________________ 4. Discount rate................................................................................................ 0.015 (1.5%) 5. Total tobacco product tax discount (multiply line 3 by line 4) ..................... $ ___________________ 6. Tobacco product tax credit (subtract line 5 from line 3) .............................. $ ___________________ I hereby swear and affirm under penalty of false swearing that the information herein and attachments are true and correct to the best of my knowledge. Print Name of Principal or Agent Date Signature of Principal or Agent 360
  • 2. Schedule A – Tobacco products returned to manufacturer or destroyed For the period of ___________________________________________ Business name ____________________________________________ Phone _________________________ Manufacturer Value of other Weight of moist tobacco products snuff on memo Date of Credit memo on memo (oz) memo ID (B) (A) Name Address Phone $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz $ oz 1. Total manufacturer refund credit value................................................................................................ $ oz 2. Tobacco products tax rates................................................................................................................... 0.50 (50%) $0.85 / oz 3. Total manufacturer refund credit tobacco products tax (multiply line 1 with line 2) Total value of column A on line 1, section 1, and column B on line 2, section 1 ............................ $ $ 360