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Application For Excise Tax Refund For Tobacco Unfit For Human Consumption ATT-24 Affidavit - Georgia
| Application For Excise Tax Refund For Tobacco Unfit For Human Consumption Form. This is a Georgia form and can be used in Alcohol And Tobacco Division Department Of Revenue Statewide . |
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ATT-24 Affidavit (Rev. 7/11) Douglas J. MacGinnitie Commissioner Department of Revenue Alcohol & Tobacco Division Suite Number 4235 1800 Century Blvd., N.E. Atlanta, Georgia 30345 (404) 417-4900 State of Georgia Howard A. Tyler Director INSTRUCTIONS FOR APPLYING FOR TOBACCO EXCISE TAX REFUND Georgia Code Section 48-11-15 provides that the Commissioner may, in certain instances, issue refunds for excise taxes paid on tobacco by a distributor, dealer or taxpayer when it can be shown to the Commissioner's satisfaction that the tobacco is unfit for human consumption or sale, and has been destroyed or shipped out of the state. Procedures for Obtaining a Tobacco Tax Refund 1. The Manufacturer must complete the most recent revision of Form ATT-24-Affidavit. Applications filed on forms other than the most recent revision of Form ATT-24-Affidavit cannot be approved. The form must be completely filled out prior to submission. A copy of the first page must be left with the retailer from whom the tobacco was picked up. The fully completed application form must be filed, by the taxpayer, with the Alcohol and Tobacco Division ("ATD") with ATT-24 Schedule C. In order to be timely filed, the application must be received by the Alcohol and Tobacco Division, P. O. Box 49728, Atlanta, GA 30359 within 90 days from the date payment of taxes was received by the Revenue Department. The ATD office will investigate the claim for tax credit and upon the completion of this investigation, will advise taxpayer of approval or disapproval of claim. Grounds for denying claim include, but are not limited to, a false statement on the application, untimely filing of an application, indebtedness by claimant to the State of Georgia, present violation by claimant of any tobacco law, or failure to meet any statutory requirement for a refund. 2. 3. An Equal Opportunity Employer American LegalNet, Inc. www.FormsWorkFlow.com ATT-24 Affidavit (Rev. 7/11) Department of Revenue ALCOHOL & TOBACCO DIVISION SUITE NUMBER 4235 1800 CENTURY BLVD., N.E. ATLANTA, GEORGIA 30345 FOR DEPARTMENT USE ONLY APPLICATION FOR EXCISE TAX REFUND FOR TOBACCO UNFIT FOR HUMAN CONSUMPTION DATE: _____________________ MANUFACTURER LICENSE NUMBER: __________________________________ REPRESENTATIVE: ____________________________________ MANUFACTURER: _________________________ LOCATION TOBACCO PICKED UP: ___________________________________________________________________ RETAILER NAME: _______________________________ RETAIL LICENSE NUMBER: ________________________ ITEM PICKED UP REASON UNFIT AMOUNT OF TAX PAID I CERTIFY THE ITEMS LISTED ABOVE HAD GEORGIA EXCISE TAX PAID ON THEM AND THEY ARE UNFIT FOR HUMAN CONSUMPTION. I FURTHER CERTIFY THESE ITEMS WERE PICKED UP TO BE TRANSPORTED TO THE MANUFACTURER'S PREMISE TO BE DESTROYED OR SHIPPED OUT OF STATE. PRINT MANUFACTURER'S REPRESENTATIVE NAME AND PHONE NUMBER: _______________________________ MANUFACTURER'S REPRESENTATIVE SIGNATURE: ___________________________________________________ I CERTIFY THAT THE MANUFACTURER'S REPRESENTATIVE REMOVED THE ABOVE ITEMS FROM MY LICENSED PREMISE AND LEFT A COPY OF THIS RECIEPT WITH ME. I FURTHER CERTIFY THAT THE MANUFACTURER'S REPRESENTATIVE DID NOT COMPENSATE ME IN ANY WAY FOR THE EXCISE TAX PAID ON THESE ITEMS. PRINT RETAIL REPRESENTATIVE'S NAME AND PHONE NUMBER: ________________________________________ RETAIL REPRESENTATIVE SIGNATURE: ______________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com ATT-24 Affidavit (Rev. 7/11) Department of Revenue ALCOHOL & TOBACCO DIVISION SUITE NUMBER 4235 1800 CENTURY BLVD., N.E. ATLANTA, GEORGIA 30345 FOR DEPARTMENT USE ONLY CERTIFICATION OF DESTRUCTION I CERTIFY THAT THE ABOVE LISTED ITEMS WERE DESTROYED ON (DATE/TIME) ________________________ AT (LOCATION) ____________________________________ BY THE FOLLOWING METHOD: __________________ ________________________________________________________________________________________________ PRINT MANUFACTURER'S REPRESENTATIVE NAME AND PHONE NUMBER: _______________________________ MANUFACTURER'S REPRESENTATIVE SIGNATURE: ___________________________________________________ PRINT WITNESS NAME AND PHONE NUMBER: ________________________________________________________ WITNESS SIGNATURE: ____________________________________________________________________________ OR CERTIFICATION OF SHIPMENT OUT OF STATE IF THE ITEMS WERE NOT DESTROYED I CERTIFIED THEY WERE SHIPPED OUT OF THE STATE OF GEORGIA ON (DATE/TIME) _________________________ TO (LOCATION) ____________________________________________. PRINT MANUFACTURER'S REPRESENTATIVE NAME AND PHONE NUMBER: _______________________________ MANUFACTURER'S REPRESENTATIVE SIGNATURE: ___________________________________________________ PRINT WITNESS NAME AND PHONE NUMBER: ________________________________________________________ WITNESS SIGNATURE: ____________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com
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