Form Inv-N - Certified Cigarette Inventory
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1INV-N
Certified Inventory
Nonresident Distributors
Certified Cigarette Inventory
Inventory at Close of Business January 31, 2008
Name
Address
City
State
Zip code
Minnesota tax ID number
# of stamps
Value of stamps
1 Minnesota stamps
Regular 20s
x $ 1.49
=
Regular 25s
x
1.8625
=
Native American 20s
x
1.49
=
Native American 25s
x
1.8625
=
Total value . . . . . . . . . . . 1 $
Minnesota stamped cigarettes (including unsaleable)
# of cartons
Value of cigarettes
Regular
= 2a
2 a. Non-fee brands (200s)
x $14.90
= 2b
b. Fee brands (200s)
x 14.90
Total cartons
Total value . . . . . . . . . . . 2 $
3 a. Non-fee brands (250s)
= 3a
x $18.625
= 3b
b. Fee brands (250s)
x 18.625
Total cartons
Total value . . . . . . . . . . . 3 $
Native American
= 4a
4 a. Non-fee brands (200s)
x $14.90
= 4b
b. Fee brands (200s)
x 14.90
Total cartons
Total value . . . . . . . . . . . 4 $
= 5a
5 a. Non-fee brands (250s)
x $18.625
= 5b
b. Fee brands (250s)
x 18.625
Total cartons
Total value . . . . . . . . . . . 5 $
6
Value of non-fee brands (add lines 2a, 3a, 4a and 5a). Also enter the result on
CT401-R, line 10B, for January 2008 and line 7b of February 2008 reconciliations . . . . . . . . . . . 6 $
7
Value of fee brands (add lines 2b, 3b, 4b and 5b). Also enter the result on
CT401-R, line 10C, for January 2008 and line 7c of February 2008 reconciliations . . . . . . . . . . . 7 $
Total value of Minnesota stamped cigarettes (add lines 6 and 7).
8
Also enter the result on CT401-R, line 10D, for January and February 2008 reconciliations . . . . . 8 $
Must be signed and certified by an officer or owner.
I certify that the above inventory has been examined by me and is true and correct to the best of my knowledge.
Authorized signature of officer or owner
Title
Date
(Rev. 12/07)
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