Form Ct303 - Tobacco Use Tax Return
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3CT303
Tobacco Use Tax Return
Use this form to pay tax on tobacco products other than cigarettes.
Name of Individual, Partnership, or Corporation
Social Security Number
Address
City
State
ZIP Code
Month
Year
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Purchased From
Invoice
Invoice
Tobacco
Premium Cigars
Moist Snuff
Total Invoice
Date
Number
Purchased
Purchased
Purchased
Price
(name/address of person or business)
If additional space is needed, attach additional sheets.
Total cost of tobacco purchased
$
1 Exemption (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
1 Total cost of tobacco purchased, excluding premium cigars and moist snuff . . . . . . . . . . . . . . . . . . . . . . . . . . 1
0.95
2 Tobacco Products Tax rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Tobacco Products Tax (multiply line 1 by line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
4 Total cost of cigars purchased for $0.525 or less . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Premium Cigar Tax (multiply line 4 by .95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
6 Number of single cigars purchased for more than $0.525 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Cigar Tax (multiply line 6 by $.50) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
8 Number of moist snuff containers purchased for $3.20 or less per container . . . . . . . . . . . . . . . . . . . . . . . . . .8
9 Moist Snuff Tax (multiply line 8 by $3.04) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9
10 Total cost of moist snuff purchased for more than $3.20 per container . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
11 Moist Snuff Tax (multiply line 10 by .95) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Total Tobacco Tax (add lines 3, 5, 7, 9, and 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 Penalties (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Interest (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Total Tax Due (add lines 12-14) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
I declare that this form is correct and complete to the best of my knowledge and belief.
Signature
Date
Daytime Phone
Mail to: Minnesota Revenue, Mail Station 3331, St. Paul, MN 55146-3331
Phone: 651-556-3035. Email: cigarette.tobacco@state.mn.us
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