Form Ct109a - Distributor Affidavit Page 2
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1
2Instructions for Form CT109A
Complete this form, sign and nota-
Damaged stamps, for which you have not
When you receive a credit memo for dam-
received a credit memo, are to be added
aged stamps, report the gross stamp value
rize. Return it to our office to receive
to your ending stamp inventory until you
on line 4 of your monthly Form CT201-R,
a credit memo for damaged or misap-
receive a credit memo.
Cigarette Reconciliation, and the net tax
plied stamps.
stamp value on line 6 of your Form CT201,
To add the damaged stamps to your ending
Cigarette Tax Monthly Return.
Misapplied or damaged
inventory, write “damaged stamps await-
Questions? Need forms?
ing credit” and indicate the number and
stamps
total tax value of the stamps on line 1 of
Website:
Damaged stamps include
your Form CT201-I, Cigarette Inventory (for
Email:
cigarette.tobacco@state.mn.us
Minnesota distributors) or Form CT401-I,
• Stamps that did not adhere to the pack-
556-3035
Phone:
651-297-1882 (TTY: Call 711 for
Cigarette Inventory (for nonresident distribu-
age,
Minnesota Relay)
tors).
• more than one stamp applied to a pack
in error, or
This value should be added to the value
of your ending stamp inventory. You must
• stamps returned to our office.
retain the packs or cartons to which the
We will reimburse you for the tax value of
damaged stamps are attached until you
these stamps.
receive a credit memo.
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