Form REV82 2109 "Non-participating Manufacturer Supplemental Reporting Form" - Washington

What Is Form REV82 2109?

This is a legal form that was released by the Washington State Department of Revenue - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 12, 2019;
  • The latest edition provided by the Washington State 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 fillable version of Form REV82 2109 by clicking the link below or browse more documents and templates provided by the Washington State Department of Revenue.

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Download Form REV82 2109 "Non-participating Manufacturer Supplemental Reporting Form" - Washington

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Washin gton State Department
Non-Participating Manufacturer
of Revenue
Taxpayer Account
Supplemental Reporting Form and Instructions
Administration Division
PO Box 47476
Olympia, Washington
98504-7476
Instructions for Completing Reverse Side
This supplemental reporting form is to be used only for
reporting sales of cigarettes to an Indian Tribal
Column A:
Organization with a Cigarette Tax Contract; RCW
43.06.450.
Enter the number of individual cigarettes sold in
Washington in packages bearing the excise tax stamp
As part of the Master Settlement Agreement between
of a tribe with a cigarette tax contract. List only
certain cigarette manufacturers and the state of
cigarettes to which you affixed the tribal or compact
Washington, the Department of Revenue is required to
excise tax stamp. Do not list cigarettes that were
compile information about cigarettes and roll-your-own
purchased with the tribal or compact tax stamp
tobacco sold in Washington. Please refer to
already affixed.
Chapter 70.157, 70.158 RCW, and WAC 458-20-264.
Column B:
Complete this form and submit it monthly if you are a
cigarette wholesaler or if you are a tobacco products
Enter the number of ounces of roll-your-own tobacco
distributor.
sold in Washington to an Indian tribal organization
with a cigarette tax contract.
Definitions
Column C:
"Cigarette" means any product that contains nicotine, is
intended to be burned or heated under ordinary
Enter the full brand name of the product sold (do not
conditions of use, and consists of or contains (i) any roll
abbreviate). Do not break down into sub-categories,
of tobacco wrapped in paper or in any substance not
such as regular, menthol, light, etc. For example, for a
containing tobacco; or (ii) tobacco, in any form, that is
cigarette named “Alpha Bravo Gold Menthol Lights”,
functional in the product, which, because of its
report only “Alpha Bravo Gold”. Do not report as “A B
appearance, the type of tobacco used in the filler, or its
Gold” or “A B Gold Menthol Lights”.
packaging and labeling, is likely to be offered to, or
Column D:
purchased by, consumers as a cigarette; or (iii) any roll of
tobacco wrapped in any substance containing tobacco,
Enter the name and address of the non-participating
which, because of its appearance, the type of tobacco
manufacturer.
used in the filler or its packaging and labeling, is likely to
Column E:
be offered to, or purchased by, consumers as a cigarette
described in clause (i) of this definition.
Enter the name and address of the person from whom
each cigarette was purchased.
The term "cigarette" includes "roll-your-own" tobacco
(i.e., any tobacco, which, because of its appearance,
Column F:
type, packaging, or labeling, is suitable for use and likely
Enter the name and address of the importer of the
to be offered to, or purchased by, consumers as tobacco
cigarette (if known).
for making cigarettes). For purposes of this definition of
"cigarette," 0.09 ounces of "roll-your-own" tobacco
constitutes one individual "cigarette."
Preparation of Schedule
"Tobacco products distributor" means any person who
If more space is required you may copy this form.
meets the definitions found in RCW 82.26.010(3).
Return the completed form 25 days after the close
"Cigarette wholesaler" means any person who is licensed
of the reporting month.
pursuant to Chapter 82.24 RCW.
Retain a copy for your files.
"Non-participating manufacturer" means any
manufacturer of cigarettes or "roll-your-own" tobacco
Please complete this schedule in full and mail to:
who is not a signatory to the Master Settlement
Washington State Department of Revenue
Agreement.
Taxpayer Account Administration Division
“Indian tribal organization” means a federally recognized
PO Box 47476
Indian tribe, or tribal entity, and includes an Indian
Olympia WA 98504-7476
wholesaler or retailer that is owned by an Indian who is
an enrolled tribal member conducting business under
tribal license or similar tribal approval within Indian
country; RCW 82.24.010(6).
To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705.
Teletype (TTY) users may use the WA Relay Service by calling 711.
REV 82 2109 (11/12/19)
Washin gton State Department
Non-Participating Manufacturer
of Revenue
Taxpayer Account
Supplemental Reporting Form and Instructions
Administration Division
PO Box 47476
Olympia, Washington
98504-7476
Instructions for Completing Reverse Side
This supplemental reporting form is to be used only for
reporting sales of cigarettes to an Indian Tribal
Column A:
Organization with a Cigarette Tax Contract; RCW
43.06.450.
Enter the number of individual cigarettes sold in
Washington in packages bearing the excise tax stamp
As part of the Master Settlement Agreement between
of a tribe with a cigarette tax contract. List only
certain cigarette manufacturers and the state of
cigarettes to which you affixed the tribal or compact
Washington, the Department of Revenue is required to
excise tax stamp. Do not list cigarettes that were
compile information about cigarettes and roll-your-own
purchased with the tribal or compact tax stamp
tobacco sold in Washington. Please refer to
already affixed.
Chapter 70.157, 70.158 RCW, and WAC 458-20-264.
Column B:
Complete this form and submit it monthly if you are a
cigarette wholesaler or if you are a tobacco products
Enter the number of ounces of roll-your-own tobacco
distributor.
sold in Washington to an Indian tribal organization
with a cigarette tax contract.
Definitions
Column C:
"Cigarette" means any product that contains nicotine, is
intended to be burned or heated under ordinary
Enter the full brand name of the product sold (do not
conditions of use, and consists of or contains (i) any roll
abbreviate). Do not break down into sub-categories,
of tobacco wrapped in paper or in any substance not
such as regular, menthol, light, etc. For example, for a
containing tobacco; or (ii) tobacco, in any form, that is
cigarette named “Alpha Bravo Gold Menthol Lights”,
functional in the product, which, because of its
report only “Alpha Bravo Gold”. Do not report as “A B
appearance, the type of tobacco used in the filler, or its
Gold” or “A B Gold Menthol Lights”.
packaging and labeling, is likely to be offered to, or
Column D:
purchased by, consumers as a cigarette; or (iii) any roll of
tobacco wrapped in any substance containing tobacco,
Enter the name and address of the non-participating
which, because of its appearance, the type of tobacco
manufacturer.
used in the filler or its packaging and labeling, is likely to
Column E:
be offered to, or purchased by, consumers as a cigarette
described in clause (i) of this definition.
Enter the name and address of the person from whom
each cigarette was purchased.
The term "cigarette" includes "roll-your-own" tobacco
(i.e., any tobacco, which, because of its appearance,
Column F:
type, packaging, or labeling, is suitable for use and likely
Enter the name and address of the importer of the
to be offered to, or purchased by, consumers as tobacco
cigarette (if known).
for making cigarettes). For purposes of this definition of
"cigarette," 0.09 ounces of "roll-your-own" tobacco
constitutes one individual "cigarette."
Preparation of Schedule
"Tobacco products distributor" means any person who
If more space is required you may copy this form.
meets the definitions found in RCW 82.26.010(3).
Return the completed form 25 days after the close
"Cigarette wholesaler" means any person who is licensed
of the reporting month.
pursuant to Chapter 82.24 RCW.
Retain a copy for your files.
"Non-participating manufacturer" means any
manufacturer of cigarettes or "roll-your-own" tobacco
Please complete this schedule in full and mail to:
who is not a signatory to the Master Settlement
Washington State Department of Revenue
Agreement.
Taxpayer Account Administration Division
“Indian tribal organization” means a federally recognized
PO Box 47476
Indian tribe, or tribal entity, and includes an Indian
Olympia WA 98504-7476
wholesaler or retailer that is owned by an Indian who is
an enrolled tribal member conducting business under
tribal license or similar tribal approval within Indian
country; RCW 82.24.010(6).
To ask about the availability of this publication in an alternate format for the visually impaired, please call 360-705-6705.
Teletype (TTY) users may use the WA Relay Service by calling 711.
REV 82 2109 (11/12/19)
Non-Participating Manufacturer
Washin gton State Department of Revenue
Return the completed form 25 days after the
Taxpayer Account Administration Division
Supplemental Reporting Form
PO Box 47476
close of the reporting month.
Olympia, Washington 98504-74776
Instructions on reverse side
Please complete this schedule in full and mail
to: Washington State Department of Revenue,
Please provide the following information with respect to cigarettes sold that were manufactured
Taxpayer Account Administration Division,
by a Non-Participating Manufacturer (NPM). This form is a supplemental form to report sales to
PO Box 47476, Olympia WA 98504-7476
an Indian Tribal Organization with a Cigarette Tax Contract.
Account ID:
Name:
Reporting Month/Yr:
mm/yy
No. of
Ounces of Roll-
Cigarettes Sold
Your-Own
Name & Address of the Person
Name & Address of the First
in Washington
Tobacco Sold in
Non-Participating Manufacturer
From Whom Each Cigarette
Importer of Foreign
(a)
Washington
Brand Name
Name & Address
Was Purchased
Manufactured Cigarettes
(b)
(c)
(d)
(e)
(f)
This report is subject to future verification by the Department of Revenue.
Reset This Form
Phone:
Signature:
Date:
REV 82 2109 (11/12/19)
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