Form Ct-111 - Cigarette Warehouse Report - Wisconsin Department Of Revenue
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2CT-111: CIGARETTE WAREHOUSE
REPORT
Tax Account Number
FEIN / SSN
Month Ending (MM DD YYYY)
Use BLACK INK Only
Cancel my permit effective
Legal Name
Business Name (DBA)
(MM DD YYYY)
Check if address, name, or entity
Permit/Business Address
change
Check if this is an amended return
City
State
Zip Code
Check if correspondence is included
Print numbers like this
Not like this
NO COMMAS
REPORT OF UNSTAMPED CIGARETTES IN WISCONSIN WAREHOUSE
Total Single Cigarettes
1
Name of Manufacturer
TOTAL
Beginning Inventory
2
(Line 7 of the preceding month)
Receivals
3
TOTAL
4
(Add Lines 2 and 3)
5
Shipments
Balance to Be Accounted for
6
(Subtract Line 5 from Line 4)
7
End of Month Physical Inventory
Inventory Discrepancies
Overage - When Line 7 exceeds Line 6 use
8
negative sign in front of the amount on Line 8.
Shortage - When Line 6 exceeds Line 7.
DECLARATION: I declare under penalties of law that I have examined this return and all attachments and, to the best of my knowledge
and belief, it is true, correct, and complete.
Preparer’s Name (please print or type)
Preparer’s Phone Number
Date
Signature of Permittee (or authorized agent)
(
)
CT-111 (R. 1-12)
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