Form Ct-001 - Native American Tribe'S Claim For Wisconsin Cigarette Tax Refund Page 2
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1
2INSTRUCTIONS
WHO IS ELIGIBLE TO FILE A REFUND CLAIM
RETURNED CIGARETTES/SHORT SHIPMENTS
Any Wisconsin Native American tribal council that has entered
Credit invoices from your supplier must accompany a refund
into an agreement with the department may file a claim for a
claim when you claim credit on line 10 for cigarettes returned
refund of the Wisconsin cigarette taxes paid on cigarettes sold
to your supplier or shorted in a shipment.
on reservation or trust land over which the tribe has jurisdic-
tion. The land on which the cigarette sales occur must have
ASSISTANCE AND FORMS
If you have questions or need more claim forms...
been designated a reservation or trust land on or before Janu-
ary 1, 1983, or on a later date if determined by an agreement
between the department and the tribal council.
• Call
(608) 266-8970
• FAX
(608) 261-7049
• E-mail: excise@revenue.wi.gov
RETAILER REQUIREMENTS
• Website:
The retailer selling the cigarettes on which the refund claim is
being filed must meet the following requirements:
1. The tribal council must have approved the retailer purchas-
SPECIFIC INSTRUCTIONS
ing and selling the cigarettes.
Line 3.
Enter the number of retail locations you have
2. The retailer cannot sell cigarettes to another retailer or cig-
approved.
arette jobber.
3. The retailer cannot deliver cigarettes to purchasers via
Line 9.
Enter the total number of tax-paid single cigarettes
common carrier, contract carrier, or the US Postal Service.
you purchased from suppliers during the time period covered
by your claim. Original invoices substantiating these purchases
NEW RETAILERS/CHANGES TO EXISTING RETAILERS
must accompany your refund claim.
The tribal council must notify the department in writing on tribal
letterhead when any of the following changes occur:
Line 10.
Enter the total number of tax-paid single cigarettes
you returned to suppliers during the time period covered by
• A new retailer is authorized to sell cigarettes.
this claim. Attach the credit invoices to your refund claim.
• The name or address of an existing retailer changes.
• An existing retailer discontinues selling cigarettes.
Line 11.
The net cigarette total entered on line 11 must agree
with the net single cigarette total entered on line 16.
FILING RESTRICTIONS ON REFUND CLAIMS
Two refund claims may be filed by a tribal council within a cal-
Line 16.
Enter the authorized retail locations covered by this
endar month.
refund claim. List each location separately and provide all the
information requested. The total net tax-paid single cigarettes
INVOICE REQUIREMENTS
you received (purchases less credit for returns and short ship-
Invoices verifying your cigarette purchases must accompany
ments) at all locations listed must agree with the amount on
your refund claim. All invoices submitted must be “original” (no
line 11.
carbon copy or photocopy).
Sign and date your completed refund claim. Send the
Each invoice must contain the following information:
claim and invoices and credit memos to the department.
1. Date of sale.
2. Name and address of purchaser.
3. Name and address where the cigarettes were delivered.
4. Name and address of seller.
5. Number of cigarettes purchased. On invoices, highlight or
note cartons of 250.
6. Date paid by purchaser. Each invoice must be marked paid,
dated, and signed by the seller or delivery person.
7. Amount of Wisconsin cigarette tax paid.
Cigarettes must have the special distinctive Native Ameri-
can cigarette tax stamp affixed.
Your invoices will be returned to you after the department has
reviewed your refund claim.
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