Form Ct201-I - Minnesota Distributors Cigarette Inventory

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CT201-I
Attachment #6
Minnesota Distributors
Cigarette Inventory
Check if certified inventory:
Licensee
Address
Minnesota Tax ID Number
Period of Return (mo/yr)
# of Stamps
Value of Stamps
1 Stamps
Regular 20s
x $ 3.614
=
Regular 25s
x
4.5175
=
Native American 20s
x
3.614
=
Native American 25s
x
4.5175
=
Total value of Minnesota stamps (also enter on CT201-R, line 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 $
Unstamped Cigarettes
# of Cartons
# of Cigarettes
2 a. Non-fee brands (20s)
x
200
=
2a
b. Fee brands (20s)
x
200
=
2b
Total cartons
Total cigarettes . . . . . . . . . . . 2
3 a. Non-fee brands (25s)
x
200
=
3a
3b
b. Fee brands (25s)
x
200
=
Total cartons
Total cigarettes . . . . . . . . . . . 3
4 a. Non-fee brands (25s)
4a
x
250
=
b. Fee brands (25s)
x
250
=
4b
Total cartons
Total cigarettes . . . . . . . . . . . 4
Other-State Stamped Cigarettes
5 a. Non-fee brands (20s)
x
200
=
5a
b. Fee brands (20s)
x
200
=
5b
Total cartons
Total cigarettes . . . . . . . . . . . 5
6 a. Non-fee brands (25s)
6a
x
200
=
b. Fee brands (25s)
x
200
=
6b
Total cartons
Total cigarettes . . . . . . . . . . . 6
7 a. Non-fee brands (25s)
x
250
=
7a
b. Fee brands (25s)
x
250
=
7b
Total cartons
Total cigarettes . . . . . . . . . . . 7
8 Total unstamped and other-state stamped cigarettes (total of lines 2 through 7) . . . . . . . . . . . . . . . . . . . . . 8
Minnesota Stamped Cigarettes (including unsaleable)
# of Cartons
# of Cigarettes
Regular
9 a. Non-fee brands (20s)
x
200
=
9a
b. Fee brands (20s)
x
200
=
9b
Total cigarettes . . . . . . . . . . . . . . . . . . . . . . . . 9
Total cartons
10 a. Non-fee brands (25s)
x
200
=
10a
b. Fee brands (25s)
x
200
=
10b
Total cartons
Total cigarettes . . . . . . . . . . . . . . . . . . . . . . . 10
11 a. Non-fee brands (25s)
x
250
=
11a
11b
b. Fee brands (25s)
x
250
=
Total cartons
Total cigarettes . . . . . . . . . . . . . . . . . . . . . . . 11
Continued on page 2.
(Rev. 1/18)
Page 2 must be signed and certified by an officer or owner.

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