Form Ct-206 - Cigarette Tax Exempt Sale Certificate - 2005

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MONTANA
CT-206
Rev 1-05
Cigarette Tax Exempt Sale Certificate
Business Name
License No.
Date
Seller or Agent Name
Phone
Address
Fax
City
State
Zip
Instruction for form preparation
1. Prepare in duplicate. Submit the original to Montana Department of Revenue, Customer Intake Process, P.O. Box
1712, Helena, MT 59604-1712. Retain a duplicate in company file for field audit purposes.
2. This form must be completed in its entirety.
3. The original form must accompany the form CT-205 – Cigarette Tax Report.
4. A copy of this form must accompany the form CT-207 – Wholesaler Refund Application.
5. The original form must be in possession of the driver of any private vehicle transporting unstamped cigarettes.
Section 1 – Type of Sale (Check One)
Stamped Cigarette Sale by Wholesaler to
Unstamped Cigarette Sale by Wholesaler to
Native American Retailer
Native American Retailer
Unstamped Cigarette Sale Wholesaler to
Wholesaler
Section 2 – Purchaser Information
___________________________________________________________________________________________
Business Name
Retailer Authorization Number
___________________________________________________________________________________________
Name of Tribe
Tribal Enrollment ID or Wholesaler License ID
___________________________________________________________________________________________
Address
City
State
Zip
___________________________________________________________________________________________
Contact Name
Social Security or FEIN
Phone
Section 3 – Cigarette Invoice Information
Delivery Date
Invoice Date
Invoice ID
200 Sticks Carton
250 Sticks Carton
Total Sticks
Print Name of Seller or Agent
Date
Signature of Principal or Agent
Print Name of Purchaser or Agent
Date
Signature of Purchaser or Agent
306

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