CT303
Tobacco Use Tax Return
Use this form to pay tax on tobacco products other than cigarettes .
Name of Individual, Partnership, or Corporation
Social Security Number
Address
City
State
ZIP Code
Month
Year
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Purchased From
Invoice
Invoice
Tobacco
Premium Cigars
Moist Snuff
Total Invoice
Date
Number
Purchased
Purchased
Purchased
Price
(name/address of person or business)
If additional space is needed, attach additional sheets.
Total cost of tobacco purchased
$
1 Exemption (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1 Total cost of tobacco purchased, excluding premium cigars and moist snuff . . . . . . . . . . . . . . . . . . . . . . 1
0 .95
2 Tobacco products tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Tobacco products tax (multiply line 1 by line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Total cost of cigars purchased for $3 .68 or less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Premium cigar tax (multiply line 4 by .95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Number of single cigars purchased for more than $3 .68 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Cigar tax (multiply line 6 by $3 .50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Use lines 8-11 beginning Jan. 1, 2014
8 Number of moist snuff containers purchased for $2 .98 or less per container . . . . . . . . . . . . . . . . . . . . . 8
9 Moist snuff tax (multiply line 8 by $2 .83) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
10 Total cost of moist snuff purchased for more than $2 .98 per container . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Moist snuff tax (multiply line 10 by .95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Total tobacco tax (add lines 3, 5, 7, 9, and 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Penalties (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Total Tax Due (add lines 12-14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
I declare that this form is correct and complete to the best of my knowledge and belief.
Signature
Date
Daytime Phone
Mail to: Minnesota Revenue, Mail Station 3331, St . Paul, MN 55146-3331
Phone: 651-556-3035 . Email: cigarette .tobacco@state .mn .us
(Rev . 8/13)