Form Ct-115 - Wisconsin Stamped Cigarette Sales To / Return From Authorized Native American Retail Stores

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CT-115: WISCONSIN STAMPED CIGARETTE SALES TO / RETURNS FROM
AUTHORIZED NATIVE AMERICAN RETAIL STORES
(File with Form CT-100 or CT-105)
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Please read the instructions before completing this form.
Name
Tax Account Number
Month/Year (mm yyyy)
Invoice
Name of
LIne
Store Location
Wisconsin Stamped
No.
Date
Number
Tribe
Authorized Retail Store
Street Address & City
Single Cigarettes
(000)
Balance Brought Forward . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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TOTAL - Add lines 1 through 29 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CT-115 (R. 1-12)
Wisconsin Department of Revenue

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