DOCTORFREER.GOV or call 336.292.0243. This form was issued under HE 2189. Please remember that if you are looking at other forms to help you with your taxes, you may need to get a new set of forms to complete them. If your state, county or municipality does not accept the tax stamps (stamps for the sale of these devices) then please provide a signed letter in addition to your tax stamp(s) which states the reason this form is required. DO NOT provide more tax stamps than are required because doing so may confuse us and prevent you from completing the rest of the form correctly.
Pay the tax with the appropriate amount shown in the appropriate boxes. If you have received this tax stamp you must be a tobacco manufacturer (manufacturer of cigarillos in any form) or importer, wholesaler, or other person that sells or delivers tobacco products in this Commonwealth. All types of tax stamps are available. If you do not know how to use it, you must call the Revenue Division at. The Tax Division, Tax Account Administration Division, is located at P.O. Box 2991, Charleston, WV 25 Earl Ray Tomlin, Governor Craig A. Griffith, Tax Commissioner The following is a list of the types of information required:
Please allow additional time based on the complexity of your tax form. If you are not sure if you need this form, you should not complete the tax return. If you believe you need the tax form, you should print and complete the necessary pages, keep the completed tax form, and mail it to the appropriate address. Be sure to enter the right Boxes.
Forms for Tobacco Manufacturers, Importers, or Wholesalers
Tobacco manufacturers or importers must fill out tax forms for tax stamps.
If you are not a tobacco manufacturer or importer, you must complete the following on the form:
The information shown on this page must match what you entered for tax stamps in Chapter 7 in the tax tables found on the last page under 'Tax Forms and Calculations.'
If you are not a manufacturer or importer, you must enter information and pay all due tax as shown on Figure 3 for each tax stamp.
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STATE OF WEST VIRGINIA State Tax Department, Tax Account Administration Div P.O. Box 2991 Charleston, WV 25330-2991 Earl Ray Tomlin, Governor Craig A. Griffith, Tax Commissioner Name Address City
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