Form B-A-MR50 "Schedule of Modified Risk Tobacco Products - 50% Risk Modification Order" - North Carolina

What Is Form B-A-MR50?

This is a legal form that was released by the North Carolina Department of Revenue - a government authority operating within North Carolina. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the North Carolina Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form B-A-MR50 by clicking the link below or browse more documents and templates provided by the North Carolina Department of Revenue.

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Download Form B-A-MR50 "Schedule of Modified Risk Tobacco Products - 50% Risk Modification Order" - North Carolina

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CAROLINA
DEPARTMENT
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u:
==
=
===
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Do Not Include This Page
·-·
N C
D(i)
R
-
I
•• · ··=!!! ::: ! : •
NORTH
::::
.
CAROLINA
DEPARTMENT
OF REVENUE
Instructions
For Handwritten
Forms
Before
Guidelines
Sending
Printing
Do not use red ink.
ocopies of returns.
Use blue or black ink.
Submit originals only.
,,___(8)
®
Do not mix form types.
Do not use dollar
Set page scaling to
signs, commas, or
"none." The Auto-Rotate
other punctuation
and Center checkbox
marks.
should be unchecked.
,
t®I
1�
1
Do not select "print on
c;
both sides of paper."
;
1
B-A-MR50
Schedule of Modified Risk Tobacco
Web
DOR Use Only
Products - 50% Risk Modification Order
9-21
Legal Name (First 35 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Schedule
Beginning
Ending
for Period
(MM-DD-YY)
(MM-DD-YY)
Trade Name
Fill in circle if applicable:
FEIN or SSN
Amended Schedule
Mailing Address
City
State
Zip Code
Phone Number
NCDOR ID/License Number
Name of Contact Person
State of Domicile
Fax Number
Part 1. Other Tobacco Products - List of Modified Risk Tobacco Products Subject to 50% Tax Reduction
Modified Risk
Cost Price of
50% Reduction of Cost
Tobacco Product
Product Manufacturer
Product Category
Modified Risk
Price of Modified Risk
Number
Tobacco Product
Tobacco Product
Total:
Add the amounts from Part 1 for this column and
enter the sum here and on Line 4, of Form B-A-101
(continued on Page 2)
Page 2,
Legal Name
NCDOR ID
B-A-MR50, Web, 9-21
Part 2. Cigarette - List of Modified Risk Tobacco Products Subject to 50% Tax Reduction
Number of Packs of Twenty
50% Reduction of Number
Modified Risk
and/or Twenty-Five of
of Packs of Twenty and/
Product Manufacturer
Product Category
Tobacco Product
Modified Risk
or Twenty-Five of Modified
Number
Tobacco Product
Risk Tobacco Product
Total:
Add the amounts from Part 2 for this column and enter the sum
here and on Line 8 of Form B-A-5 or on Line 1 of Form B-A-6,
whichever is applicable.
Legal Name
NCDOR ID
Page 3,
B-A-MR50, Web, 9-21
Part 3. Vapor Products - List of Modified Risk Tobacco Products Subject to 50% Tax Reduction
Number of Milliliters of
50% Reduction of Number
Modified Risk
Product Manufacturer
Product Category
Modified Risk
of Milliliters of Modified Risk
Tobacco Product
Tobacco Product
Tobacco Product
Number
Total:
Add the amounts from Part 3 for this column and enter the sum
here and on Line 4 of Form B-A-102.
Signature:
Title:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
Mail to: North Carolina Department of Revenue, PO Box 25000, Raleigh, North Carolina 27640-0110.
Questions: Contact Excise Tax Division at: Telephone Number: (919) 733-3641; Fax Number: (919) 250-7898
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