Form Ct401-C - Nonresident Distributors - Minnesota Cigarette Sales

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CT401-C
Nonresident Distributors
Attachment #3
Minnesota Cigarette Sales
Read instructions on back.
Licensee
Address
Minnesota tax ID number
Period of return (mo/yr)
Page
of
Invoice
Cigarettes Sold to:
A
B
C
Date
Number
Name and Address
Non-Fee Brands
Fee Brands
Total Cigarettes (A + B)
Enter totals from previous page, if any
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19 Total. If this is the final page, also enter totals on CT401-R, lines 12B, 12C and 12D . . . . . . . . . . . . . . . A.
B.
C.
(Rev. 1/12)

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