Form Ct501-I - Cigarette Inventory For Minnesota Importers

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CT501-I
Attachment #4
Cigarette Inventory for Minnesota Importers
Check if certified inventory:
Licensee
Address
Minnesota tax ID number
Period of return (mo/yr)
Cigarette Ending Inventory
# of Cartons
# of Cigarettes
1 a. Non-fee brands (20s)
x
200
=
1a
b. Fee brands (20s)
x
200
=
1b
Total cartons
Total cigarettes . . . . . . . . . . 1
2 a. Non-fee brands (25s)
x
200
=
2a
b. Fee brands (25s)
x
200
=
2b
Total cartons
Total cigarettes . . . . . . . . . . 2
3 Total non-fee brands (add lines 1a and 2a; also enter on CT501-R, line 5A) . . . . . . . . . . . . . . . . . . . . . . . 3
4 Total fee brands (add lines 1b and 2b; also enter on CT501-R, line 5B) . . . . . . . . . . . . . . . . . . . . . . . . . . 4
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
(Rev. 1/12)

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