Fillable Cigaree Inventory CT401-I Nonresident Distributors (Minnesota Department of Revenue)

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Cigaree Inventory CT401-I Nonresident Distributors (Minnesota Department of Revenue)

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Stamps
Authorized Signature of Ocer or Owner Title Date
Nonresident Distributors
Cigaree Inventory
# of Stamps Value of Stamps
1 Minnesota stamps
Regular 20s x $ 3.673 =
Regular 25s x 4.5913 =
Nave American 20s x 3.673 =
Nave American 25s x 4.5913 =
Total value of Minnesota stamps (also enter on CT401-R, line 5) .................................... 1 $
Minnesota Stamped Cigarees (including unsaleable)
# of Cartons Value of Cigarees
Regular
2 a. Non-fee brands (20s - 200 ct) x $36.73 = 2a
b. Fee brands (20s - 200 ct) x 36.73 = 2b
Total cartons Total value ............... 2 $
3 a. Non-fee brands (25s - 200 ct) x $36.73 = 3a
b. Fee brands (25s - 200 ct) x 36.73 = 3b
Total cartons Total value ............... 3 $
Nave American
4 a. Non-fee brands (20s - 200 ct) x $36.73 = 4a
b. Fee brands (20s - 200 ct) x 36.73 = 4b
Total cartons Total value ............... 4 $
5 a. Non-fee brands (25s - 200 ct) x $36.73 = 5a
b. Fee brands (25s - 200 ct) x 36.73 = 5b
Total cartons Total value ............... 5 $
6 Value of non-fee brands (add lines 2a, 3a, 4a and 5a; also enter on CT401-R, line 10B) ................. 6 $
7 Value of fee brands (add lines 2b, 3b, 4b and 5b; also enter on CT401-R, line 10C) ..................... 7 $
8 Total value of Minnesota stamped cigarees (add lines 6 and 7; also enter on CT401-R, line 10D) ........ 8 $
CT401-I
Minnesota Stamped CigareesSign Here
(Rev. 1/21)
Must be signed and cered by an ocer or owner.
I cerfy that the above inventory has been examined by me and is true and correct to the best of my knowledge.
Aachment #4
Licensee Address Minnesota Tax ID Number Period of Return (mo/yr)
Check if cered inventory:
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Cigaree Inventory CT401-I Nonresident Distributors (Minnesota Department of Revenue)

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Completed 7 February 2021

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