CN1
Contamination Tax Return
Assessment for Taxes Payable
(year)
(year)
County Treasurer: Use Form CN1 to report all contamination tax collected by the county and to determine
and pay the state’s share . Report parcels paying the contamination tax on Schedule A .
County
Minnesota tax ID number
Check here if amended return
Address
Contact person
City
State
Zip code
Contact email
Phone number
MN
Reporting period (check one):
First Half Taxes
Second Half Taxes
For each of the following tax rates, enter the number of
Column A
Column B
Number of Parcels
Total Tax Collected
parcels in column A and the tax collected in column B
(round to nearest dollar)
1 100 percent rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 25 percent rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 50 percent rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 12 .5 percent rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Determining the state’s share of the tax collected on lines 3 and 4
5 Total tax collected at 50 percent and 12 .5 percent rates
(add line 3, column B, and line 4, column B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
.95
6 Counties are allowed to retain 5 percent of the tax collected for administering the tax . . . . . . . . . . . . . . . 6
All payments must be paid
electronically (see below)
7 Total contamination tax due to the state (multiply line 5 by line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
County Treasurer’s signature
Printed name
Date
County Assessor’s signature
Printed name
Date
To pay electronically, go at www .revenue .state .mn .us and login to e-Services .
Email, fax or mail a signed copy of Form CN1 and Schedules A to:
Email: contamination .tax@state .mn .us
Fax: 651-297-1939
Mail: Special Taxes Division — Contamination Tax, Mail Station 3331, St . Paul, MN 55146-3331
Phone: 651-556-4721 (TTY: Call 711 for Minnesota Relay) .
(Rev . 01/12)