Form Ct501-D - Out-Of-State Cigarette Sales

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CT501-D
Attachment #3
Minnesota Importers
Out-of-State Cigarette Sales
Read instructions on back . Complete a separate form for each state .
Licensee
Address
Minnesota tax ID number
Period of return (mo/yr)
Page
of
A
B
C
Invoice
Cigarettes sold to:
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 CT501-R, lines 4A, 4B and 4C . . . . . . . . . . . .
A.
B.
C.
(Rev . 1/08)

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