Application for a Refund of the Tobacco Tax and the Specific Tax on Alcoholic Beverages Following the Theft of (or Damage to) Merchandise
LM-21-V

This form is to be used to apply for a refund of the tobacco tax and the specific tax on alcoholic beverages following the theft of or damage to merchandise. Any such application must be made within four years of the date on which the merchandise was stolen or damaged.

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If you wish to apply for a refund of the tobacco tax, consult the Tobacco Tax Rate Table (TA-1-V) to find out which tax rates apply to your situation before you complete form LM-21-V.

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This form can be signed electronically.

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