215 W 10th Street, Ste 204 2025

1. Click ‘Get Form’ to open the document in the editor.
2. Begin by entering your Business Name and State Tax ID in the designated fields at the top of the form.
3. In the section labeled 'Unprocessed Retail Marijuana Transferred during', specify the month and year for reporting.
4. For each item listed (e.g., Weight in Pounds of Bud/Flower Transferred), input the corresponding weight or number in the provided fields. Multiply these values by their respective rates to calculate taxable values.
5. Sum up all taxable values from lines 1 to 7 to determine your Total Valuation of AMR.
6. Add your Total Contract Sales to the Total Valuation to get line 10's value.
7. Multiply line 10 by the County Excise Tax Rate to find your Excise Tax amount.
8. Include any penalties, interest, or late fees, then calculate your Total Amount Due.
9. Finally, certify your information by signing and dating at the bottom of the form, along with providing your printed name, title, and phone number.

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