Form Ct401-B - Credit For Returned Cigarettes
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1CT401-B
Attachment #2
Nonresident Distributors
Page
of
Credit for Returned Cigarettes
Licensee
Address
Minnesota Tax ID Number
Period of Return (mo/yr)
Enter number of cigarettes (not packs or cartons) returned to the manufacturer. Report cigarettes during month of return, not the
month credit memo is received.
Credit for Non-Fee Brands
Credit Memo
RGA
Manufacturer
Minnesota Stamped
Date
Number
Number*
1
2
3
4
5
6
7
8
9
10 Total non-fee cigarettes (add lines 1 through 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
$
11 Value of non-fee cigarettes (multiply line 10 by 0.18070 [mill rate]) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Enter on CT401-R, line 9B
Credit for Fee Brands
Credit Memo
RGA
Manufacturer
Minnesota Stamped
Date
Number
Number*
12
13
14
15
16
17
18
19
20
21 Total fee cigarettes (add lines 12 through 20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
$
22 Value of fee cigarettes (multiply line 21 by 0.18070 [mill rate]) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Enter on CT401-R, line 9C
23 Total number of Minnesota stamped cigarettes (add lines 10 and 21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
$
24 Total value of Minnesota stamped cigarettes (add lines 11 and 22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Enter on CT401-R, line 9D
* Returned Goods Authorization (RGA) number.
(Rev. 1/18)
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