Form Ct201-Lc - Little Cigars Stamped
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1
2CT201-LC
Little Cigars Stamped
Check if amended:
Little cigars reported on this schedule should not be reported on CT201-A, CT201-B, CT201-C, or CT201-I .
Licensee
FEIN
Street
Minnesota Tax ID Number
Check if New Address
City
State
ZIP Code
Period of Return (mo/yr)
Number of Little Cigars Stamped (less than 3lbs per thousand)
A
B
C
Number of
Total number
Brand
sticks per pack
Number of packs
of sticks (multiply A by B)
1
Line 1 Totals (add column B and column C for all brands) . . . . . . . . . . . . . . . 1b
1c
2 Tax due (multiply line 1c by 0.1795) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
3 Total tax paid (multiply line 1b by 3.59) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Net tax/credit (subtract line 3 from line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Number of Little Cigars Stamped (3lbs to 4.5lbs per thousand)
A
B
C
Number of
Total number
Brand
sticks per pack
Number of packs
of sticks (multiply A by B)
5
Line 5 Totals (add column B and column C for all brands) . . . . . . . . . . . . . . . 5b
5c
6 Tax due (multiply line 5c by 0.1795) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Total tax paid (multiply line 5b by 3.59) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
8 Net tax/credit (subtract line 7 from line 6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
9 TOTAL TAX/CREDIT (add lines 4 and 8; enter the amount here and on CT201, line 11) . . . . . . . . . . . . . 9
I declare that this return is correct and complete to the best of my knowledge and belief.
Authorized Signature
Title
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
(Rev . 1/17)
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