Form Ct-201i- Cigarette Inventory - 2000

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MINNESOTA Department of Revenue
CT-201I
Cigarette Inventory
Attachment sequence #5
Note: • Sales and inventory for each month must be cut off at the exact same time.
• “Mis-stamps” are stamps for which you have not yet received credit.
Licensee
Minnesota tax ID number
Period of return (month/year)
Date and time of inventory
Number of stamps
Value of stamps
1 Stamps
Regular 20s
x $ 0.48
=
Regular 25s
x
0.60
=
Regular 10s
x
0.24
=
Native American 20s
x
0.48
=
Native American 25s
x
0.60
=
Mis-stamps 20s
x
0.48
=
Mis-stamps 25s
x
0.60
=
Total Minnesota stamps (fill in this amount on Schedule CT-201R, line 5) . . . . . . . . . . . . . . . . . 1 $
Number of cartons
Number of cigarettes
2 Unstamped cigarettes
Cartons of cigarettes
x
200
=
Cartons of cigarettes
x
250
=
Other-state stamped cigarettes
Cartons of cigarettes
x
200
=
Cartons of cigarettes
x
250
=
Total number of cigarettes (fill in this amount on Schedule CT-201R, line 13) . . . . . . . . . . . . . . 2
Qty
3 Minnesota stamped cigarettes (including unsaleable)
Cartons of regular
x
200
=
Cartons of regular
x
250
=
Cartons of Native American
x
200
=
Cartons of Native American
x
250
=
Total number of Minnesota-stamped cigarettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Qty
4 Minnesota stamped cigarettes (including unsaleable)
Number of cartons
Tax value of cigarettes
Cartons of regular 200
x $ 4.80
=
Cartons of regular 250
x
6.00
=
Cartons of Nat. Amer. 200
x
4.80
=
Cartons of Nat. Amer. 250
x
6.00
=
Total Minnesota stamped cigarettes (fill in this amount on Schedule CT-201R, line 19) . . . . . . . 4 $
Authorized signature
Date
Notary signature (if needed)
Date
(Rev. 5/00)

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