Form Tsr - Tobacco Sales On Reservations

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TSR
Tobacco Sales on Reservations
You must attach copies of the invoices.
Licensee
Address
Minnesota Tax ID Number
Period of Return (mo/yr)
Page
of
Store Location
Column A
Column B
Column C
Column D
Invoice
Authorized
Address
Tobacco
Cigar
Moist Snuff
Total Tax
Tribe
Number
Date
Retail Store
City, ZIP Code
Products Tax*
Tax
Tax
(Column A + B + C)
Total 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 Tobacco Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
*Not including tax on cigar and moist snuff.
(Rev. 1/18)

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