Form Ct201-I - Minnesota Distributors Cigarette Inventory Page 2
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2CT201-I
(p. 2)
Licensee
Address
Minnesota tax ID number
Period of return (mo/yr)
Native American
# of Cartons
# of Cigarettes
12 a. Non-fee brands (20s)
x
200
=
12a
b. Fee brands (20s)
x
200
=
12b
Total cartons
Total cigarettes . . . . . . . . 12
13 a. Non-fee brands (25s)
x
200
=
13a
b. Fee brands (25s)
x
200
=
13b
Total cartons
Total cigarettes . . . . . . . . 13
14 a. Non-fee brands (25s)
x
250
= 14a
b. Fee brands (25s)
x
250
= 14b
Total cartons
Total cigarettes . . . . . . . . 14
15 Total Minnesota stamped cigarettes (add lines 9 through 14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
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
Daytime phone
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Parent category: Financial