The Missouri 4795 form is a document required by the Missouri Department of Revenue for reporting tobacco products exported to states outside of Missouri. This form facilitates the tracking of retailer export sales and ensures compliance with state regulations. To streamline your reporting process, consider filling out the form by clicking the button below.
The Missouri 4795 form plays a crucial role for retailers dealing in tobacco products other than cigarettes. It is specifically designed for those who export tobacco products outside the state of Missouri. This form requires detailed information about the sales, including the invoice date, invoice number, and the recipient's shipping address. Retailers must also indicate the manufacturer’s invoice price before any discounts. Each exported sale to a different state necessitates a separate schedule, ensuring that all transactions are properly documented. Additionally, the form requires the total amount from each schedule to be reported on another form, known as Form 4341. To comply with state regulations, retailers must submit two copies of each state's schedule. For any questions or further assistance, the Missouri Department of Revenue provides contact information, including phone and email options, making it easier for retailers to navigate this process.
Form
Missouri Department of Revenue
Tobacco Products - Other Than Cigarettes
Document Locator Number
4795 Retailer Export Sales - Schedule A
Company
License Number
Month and Year
___ ___ / ___ ___ ___ ___
Tobacco Products Exported to State of:
Complete a separate schedule for each state to which product is exported if sales were made to persons outside the State of Missouri. Please submit two copies of each state’s schedule.
Your Invoice
Date
Number
To Whom Sold
Ship To Address
(Street, City, State, Zip)
Manufacturer’s Invoice Price (Before Discounts and Deals)
$
Schedule Total (Enter on Line 4A of Form 4341)
Form 4795 (Revised 04-2014)
Mail To: Taxation Division
Phone: (573) 751-5772
P.O. Box 3320
Fax: (573) 522-1720
Visit http://www.dor.mo.gov/business/tobacco/
Jefferson City, MO 65105-3320
TDD: (800) 735-2966
for additional information.
E-mail: excise@dor.mo.gov
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