Form Ct-100 - Wisconsin Distributor'S Cigarette Tax Reutrn Page 2
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1
22 of 2
Page
–1000
(1000)
ENTER NEGATIVE NUMBERS LIKE THIS
NOT LIKE THIS
NO COMMAS
SECTION 3
COMPUTATION OF AMOUNT DUE
15. Gross value of Wisconsin stamps purchased (from CT-104 column H, line 19) . . . . . . . . 15
.00
1 6. Less bad debt cigarette tax deduction (from CT-117, column G, line 17) . . . . . . . . . . . . . 16
.00
.00
17 . Add bad debt cigarette tax repayment (attach schedule and explanation) . . . . . . . . . . . . 17
1 8. NET AMOUNT (line 15 less line 16 plus line 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
.00
1 9. Less 0.7% discount (multiply line 18 by 0.007) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
.00
2 0. NET CIGARETTE TAX (line 18 minus line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
.00
2 1. Total printing costs (from CT-104, column C, line 19) . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
.00
2 2. TOTAL AMOUNT DUE - (add lines 20 and 21, if result is greater than or equal to zero) . 22
.00
2 3. TOTAL REFUND CLAIMED - (add lines 20 and 21, if result is less than zero) . . . . . . . . 23
.00
SECTION 4
MASTER SETTLEMENT AGREEMENT REPORTING
2 4. Do you have any Master Settlement Agreement (MSA) reporting requirements
for Non-Participating Manufacturer’s products for this period? . . . . . . . . . . . . . . . . . . . . 24
Yes
No
If yes, complete Form CT-101.
Check here if your required MSA e-mail address has changed. New address
DECLARATION: I declare under penalties of law that I have examined this return and all attachments and, to the best of my knowledge
and belief, it is true, correct, and complete.
Signature of Permittee (or authorized agent)
Preparer’s Name (please print or type)
Preparer’s Phone Number
Date
(
)
This form must be filed electronically at
For questions contact us at:
Call: (608) 266-8970
Mailing Address
Excise Tax Section 6-107
Fax: (608) 261-7049
Wisconsin Department of Revenue
E-mail: excise@revenue.wi.gov
PO Box 8900
Web site:
Madison WI 53708-8900
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