Form Ct401 - Nonresident Distributors Cigarette Tax Monthly Return

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CT401
Nonresident Distributors
Cigarette Tax Monthly Return
You must file this return even if no stamps were received during the month.
Check if amended:
Due on or before the 18th day of the month following the end of the reporting month.
Licensee
FEIN
Address
Minnesota Tax ID Number
City
State
ZIP Code
Period of Return (month/year)
1 Stamps purchased
Date
Invoice #
Net amount due
Total net amount due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Use Tax due since last return filed (attach schedule showing your computation) . . . . . . . . . . . . . . . . . . . . . . . 2
3 Add lines 1 and 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Advance payments. Enter total net amount paid (attach copy of checks) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Credit carryforward. (If line 11 of the preceding month’s CT401 is a credit,
enter that amount here; otherwise leave blank) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Other credits. (Complete only if instructed by the department) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Credits. (Enter any credits requested this month; attach copy of Form CT109A or Manufacturer Affidavit)
A
B
C
D
E
F
Date of
Affidavit
Manufacturer
20s
25s
Tax value
Affidavit
Number
(# of stamps) (# of stamps)
(see line 7 instructions)
$
$
$
$
$
$
$
Total tax values . . . . . . 7
8 Add lines 4 through 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 Monthly Cigarette Tax (subtract line 8 from line 3; if line 8 is more than line 3, contact us) . . . . . . . . . . . . . . 9
10 Monthly Cigarette Fee (from CT401-F, line 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Monthly Little Cigar Tax (from CT401-LC, line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 AMOUNT YOU OWE (or credit carryforward) (add lines 9, 10, and 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Check payment method:
Electronic payment
Check
(make payable to Minnesota Revenue)
I declare that this return and supporting schedules are correct and complete to the best of my knowledge and belief.
Authorized Signature
Title
Date
Daytime Phone
Attach schedules and mail to Minnesota Revenue, Mail Station 3331, St. Paul, MN 55146-3331.
Phone: 651-556-3035. Email: cigarette.tobacco@state.mn.us
(Rev. 1/18)

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