Form Ct-201a - Cigarette Receipts Spreadsheet

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MINNESOTA Department of Revenue
CT-201A
Cigarette Receipts
Attachment sequence #2
Fill in the number of cigarettes received during the month. Be sure to include invoice numbers (not bill-of-lading or standing-order numbers) .
Short shipments: Report only cigarettes actually received; report back-ordered cigarettes when they come in using the invoice number to
Page
which the back-order applies. Credit memos: Report the invoice in full, and record the credit memo on Schedule CT-201B.
No cigarettes received during the month: Write “none” on the first line.
Licensee
Minnesota tax ID number
Period of return (month/year):
Number of unstamped cigarettes (include complimentary cigarettes)
Date
Brown &
Other manufacturers
rec’d
Invoice #
Williamson
Ligget
Lorillard
Philip Morris
R.J. Reynolds
Total
name
qty
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Page total
24
(add columns this page only)
Total all pages
25
(fill in on last page only)
(Rev. 5/00)

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