Form Ct201-N - Cigarette Sales On Native Reservations

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CT201-N
Minnesota Distributors
Cigarette Sales on Native Reservations
You must attach copies of the invoices.
Licensee
Address
Minnesota tax ID number
Period of return (mo/yr)
Page
of
A — Non-Fee Brands
B — Fee Brands
C— Little Cigars
Date
Tribe
rec’d
Invoice #
Authorized Retail Store, Address, City, Zip Code
Quantity in sticks
Quantity in sticks
Quantity in sticks
Totals from previous page, if any
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19 Total cigarettes and little cigars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
(Rev. 6/13)

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