Form Ct109a - Distributor Affidavit Page 2
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1
2Instructions for Form CT109A
Complete this form, sign and nota-
Questions? Need forms?
You can take a credit for the tax value of
these stamps. Follow the instructions and
rize. Return it to our office to receive
Website:
take the credit for damaged stamps on line
a credit memo for damaged or mis-
Email: cigarette.tobacco@state.mn.us
7 of Form CT201 or Form CT401. In the
applied stamps.
month you are requesting the credit, report
Phone: 651-556-3035
the gross stamp value on line 4 of your
Misapplied or damaged
monthly Form CT201-R or Form CT401-R.
Fax:
651-556-5236
stamps
This information is available in alternate
Damaged stamps include
formats.
• Stamps that did not adhere to the
package,
• more than one stamp applied to a pack
in error, or
• stamps returned to our office.
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Parent category: Financial