Fillable CITY OF VIRGINIA BEACH COMMISSIONER OF THE REVENUE (City of Virginia Beach)

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CITY OF VIRGINIA BEACH COMMISSIONER OF THE REVENUE (City of Virginia Beach)

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CITY OF VIRGINIA BEACH
COMMISSIONER OF THE REVENUE
2401 COURTHOUSE DRIVE
VIRGINIA BEACH, VA 23456-9002
Telephone: 757-385-4515/Email: Business@VBGov.com
APPLICATION FOR CIGARETTE TAX CREDIT
Owner Name:
(For Commissioner’s Office Use Only)
Trade Name:
Address:
City, State, Zip:
Federal ID #:
The above named qualified Virginia tobacco wholesaler hereby makes application to the City of Virginia Beach for
a cigarette tax credit for the reasons and in the amount stated below.
REASON No. of Stamps
Tax Value Each
Stamp
Gross Tax Value
Stamps erroneously applied on packages $
Stamps applied on cartons
Unusable stamps on decorative rolls
Other (specify)
Stamps on unusable tobacco products returned to manufacturer
Total
$
Less 8% discount
Net amount of this application for credit certificate
$
T
his application is supported by the attached manufacturers affidavit executed by the manufacturer and an affidavit that
supports proof of purchase date by the wholesaler.
Name of Qualified Wholesaler
By: ______________________________________
Date: _______________
Title: ____________________________________
Contact Phone #: __________________________
Cigarette Tax Credit App
Revised 09.01.2015
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CITY OF VIRGINIA BEACH COMMISSIONER OF THE REVENUE (City of Virginia Beach)

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Completed 4 June 2021

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