Form Ct211 - Cigarette Stamp Order
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1CT211
Cigarette Stamp Order Form
Orders will be accepted by mail or fax only:
Minnesota Revenue
Mail Station 3331
St. Paul, MN 55146
Fax: 651-556-3170
Orders received after 1:00 p.m., Central Standard Time, will be processed the next business day.
Name
Minnesota tax ID number
Date:
Check one:
Name of business
UPS Standard Shipping
Address
UPS Code:
UPS Overnight Shipping
City
State
Zip code
UPS Code:
Pick-up time
Phone
Fax
For morning pick-up, order by 8 a.m.
For afternoon pick-up, order by 11 a.m.
For office use only
Order #:
Stamp serial #
20s
Quantity
Total # of stamps
begin
end
Rolls x 30,000 =
Pads x 1,500 =
Wide pads x 1,500 =
25s
Quantity
Total # of stamps
Rolls x 7,200 =
Pads x 1,500 =
Native American
Quantity
Total # of stamps
Rolls of 20s x 30,000 =
Pads of 20s x 1,500 =
Pads of 25s x 1,500 =
This is a legal document — a written contract for the sale of goods
Pursuant to the Uniform Commercial Code as set forth in Minnesota Statutes, this is a shipment contract. Under this contract, the pur-
chaser bears the risk of loss after, as indicated above by the purchaser, the department either delivers the stamps to the chosen carrier or
the purchaser picks the stamps up directly from the department. In the absence of the purchaser choosing an alternative, the depart-
ment will ship by UPS and the stamps will be insured at UPS’s minimum liability value.
Questions? Phone: 651-556-3035 (TTY: Call 711 for Minnesota Relay). Email: cigarette.tobacco@state.mn.us
(Rev. 5/12)
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