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GEORGIA CIGAR, LITTLE CIGAR, AND LOOSE AND SMOKELESS TOBACCO

EXCISE TAX MONTHLY RETURN

Georgia Department of Revenue Alcohol and Tobacco Division P.O. Box 49728 Atlanta, GA 30359

Georgia Retailer

Return to be filed on or before the 10th day of the following month for which the report is filed

Legal Business Name

Pramukh Swmi, LLC

DBA Tobacco Palace

STI#

20114914861

State License No. 0043050

Jun-14

Address

250

(Street)

Plaza Suite 121

Golden Isles

Zip Code

31520

Line # SUMMARY OF TRANSACTIONS DURING MONTH Loose Tobacco
(Whole Cost Price)
Smokeless
(Whole Cost Price)
Large Cigars
(Whole Cost Price)
Lttle Cigars
(Whole Cost Price)
1 Total Purchases and Tranfers From All Distributors/Importers (Schedule A) 0.00 - 10,688.01 -
2 Georgia Tax Paid Purchases and Tranfers From All Distributors/Importers - - - -
3 Non-Georgia Tax Purchases and Tranfers From All Distributors/Importers - - - -
4 GA. Ending Taxable Purchases (Lines 1-2 = Ending Taxable Sales) 0.00 - 10,688.01 -
5 Tax Rate 10% 10% 23% 0.0025
6 Gross Tax Due (Line 4 x Tax Rate on Line 5) $0.00 - $2,458.24 -
7 Previous Overpayment of Tax Paid on Product - - - -
8 Net Tax Due (Line 6 Less Line 7) $0.00 - $2,458.24 -
9 - - - TOTAL $2,458.24

$2,458.24

AFFIDAVIT

I certify, under the penalties for filing false returns, that I have personal knowledge and understanding of statements made in this return and that the figures presented

herein, including accompanying schedules, are true, correct and complete to the best of my knowledge and belief, and are filed in accordance with the law.