Fillable Form Ct-30 - Cigarette Tax Refund Claim (Page 2 of 2) in pdf

Form Ct-30 - Cigarette Tax Refund Claim Page 2

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I have audited the reports of the distributor named above, and find that a credit memorandum dated _____________ in the amount of $ ____________

was issued by the manufacturer named above to the distributor.

Signature of Revenue Examiner

Credit Approved by:

Audit Supervisor - Excise Taxes Unit

Cigarette Tax Stamp Refund Instructions

General Instructions

Part 1: Distributor’s Affidavit

Conn. Gen. Stat. §12-300 and Conn. Agencies Regs.

The distributor must complete Part 1 of Form CT-30 and sign it

§12-313-4a require a licensed cigarette distributor to complete

before a notary public

Part 1. Once completed and notarized, the licensed cigarette

Part 2: Manufacturer’s Affidavit

distributor must forward Form CT-30 to the manufacturer, who,

as required by Conn. Gen. Stat §12-300 and Conn. Agencies

The manufacturer must complete Part 2 of Form CT-30 and

Regs. §12-313-4a, must complete Part 2 and return it to the

sign it before a notary public.

distributor. The Department of Revenue Services (DRS) will

Part 3: DRS Use Only

not issue a refund unless both Part 1 and Part 2 are properly

completed.

DRS completes this section.

Rounding Off to Whole Dollars:

You must round off cents

Additional Information

to the nearest whole dollar on your cigarette tax refund claim.

Round down to the next lowest dollar all amounts that include

If you need additional information or assistance, call the Excise

1 through 49 cents. Round up to the next highest dollar all

Taxes Unit at 860-541-3224, Monday through Friday, 8:30 a.m.

amounts that include 50 through 99 cents. However, if you

to 4:30 p.m. Visit the DRS website at to

need to add two or more amounts to compute the total amount

download and print Connecticut tax forms.

to enter on a line, include cents and round off only the total.

If you do not round, DRS will disregard the cents.

Example: Add two amounts ($1.29 + $3.21) to compute the

total ($4.50) to enter on a line. $4.50 is rounded to $5.00 and

entered on the line.

CT-30 Back (Rev. 07/07)

Form Ct-30 - Cigarette Tax Refund Claim Page 2

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