<?xml version="1.0" encoding="UTF-8"?>
<!--Sample XML file generated by XMLSpy v2018 sp1 (x64) (http://www.altova.com)-->
<ReturnState xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
	<SubmissionId>00000000012018080c01</SubmissionId>
	<ReturnHeaderState>
		<Jurisdiction>WI</Jurisdiction>
		<Timestamp>2018-03-21T09:30:47Z</Timestamp>
		<TaxPeriodBeginDate>2018-02-01</TaxPeriodBeginDate>
		<TaxPeriodEndDate>2018-02-28</TaxPeriodEndDate>
		<TaxYear>2018</TaxYear>
		<SoftwareId>XMLSpy</SoftwareId>
		<SoftwareVersion>1</SoftwareVersion>
		<InternetProtocol>
			<IPAddress>
				<IPv4AddressTxt>0.0.0.0</IPv4AddressTxt>
			</IPAddress>
			<IPTimestamp>2001-12-17T09:30:47Z</IPTimestamp>
		</InternetProtocol>
		<SignatureOption>
			<SignatureDocument>Mail</SignatureDocument>
		</SignatureOption>
		<AmendedReturnIndicator>X</AmendedReturnIndicator>
		<OriginalSubmissionId>00000000012018079c01</OriginalSubmissionId>
		<OriginalSubmissionDate>2018-03-20</OriginalSubmissionDate>
		<ReturnType>FormCT100</ReturnType>
		<Filer>
			<EIN>000000000</EIN>
			<StateEIN>400000000000107</StateEIN>
			<Name>
				<BusinessNameLine1Txt>Sample Cigarette Business</BusinessNameLine1Txt>
				<BusinessNameLine2Txt>Joes Cigarettes</BusinessNameLine2Txt>
			</Name>
			<USAddress>
				<AddressLine1Txt>2135 Rimrock Rd</AddressLine1Txt>
				<CityNm>Madison</CityNm>
				<StateAbbreviationCd>WI</StateAbbreviationCd>
				<ZIPCd>53708</ZIPCd>
			</USAddress>
		</Filer>
		<BusinessRepresentative>
			<PersonName>
				<FirstName>Joe</FirstName>
				<LastName>Tester</LastName>
			</PersonName>
			<PersonTitleTxt>Cheif Tester</PersonTitleTxt>
			<PhoneNum>6085551212</PhoneNum>
			<EmailAddressTxt>Joe.Tester@joetester.com</EmailAddressTxt>
		</BusinessRepresentative>
	</ReturnHeaderState>
	<ReturnDataState>
		<FormCT100>
			<Header>
				<CancelPermitEffectiveDt>1957-08-13</CancelPermitEffectiveDt>
				<AddressNameEntityChange>X</AddressNameEntityChange>
			</Header>
			<SectionOne>
				<PhysicalInventoryBegin>95800</PhysicalInventoryBegin>
				<GrossTaxCigarettes>12005600</GrossTaxCigarettes>
				<PhysicalInventoryEnd>1669600</PhysicalInventoryEnd>
			</SectionOne>
			<SectionThree>
				<NetCigaretteTax>1388810.00</NetCigaretteTax>
				<TotalAmtDue>1389310.00</TotalAmtDue>
			</SectionThree>
			<SectionFour>
				<HaveMSARequirement>Yes</HaveMSARequirement>
			</SectionFour>
		</FormCT100>
		<SchTransaction>
			<Schedule>
				<TypeOfSchedule>1C</TypeOfSchedule>
				<TransactionDocument>
					<Date>2018-02-02</Date>
					<TypeOfTransDoc>Purchase Order</TypeOfTransDoc>
					<DocNumber>12345</DocNumber>
					<TypeOfCustomer>Retailer</TypeOfCustomer>
					<Name>
						<BusinessNameLine1Txt>Distributor Alpha</BusinessNameLine1Txt>
					</Name>
					<Address>
						<USAddress>
							<AddressLine1Txt>123 Test Lane</AddressLine1Txt>
							<CityNm>Testerville</CityNm>
							<StateAbbreviationCd>WI</StateAbbreviationCd>
							<ZIPCd>54321</ZIPCd>
						</USAddress>
						<TypeOfAddress>Billing</TypeOfAddress>
					</Address>
					<EIN>000000006</EIN>
					<StateEIN>400000000000207</StateEIN>
					<CustomerID>DA321</CustomerID>
					<Transactions>
						<FedDesc>Cigarette</FedDesc>
						<MSAStatus>NPM</MSAStatus>
						<TaxJurisdiction>WI</TaxJurisdiction>
						<UPCNumber/>
						<UPCUOM>PAK</UPCUOM>
						<Manufacturer>Test Manufacturer</Manufacturer>
						<ManufacturerEIN>000000021</ManufacturerEIN>
						<BrandFamily>Test Family</BrandFamily>
						<Quantity>12</Quantity>
						<SticksPerPack>20</SticksPerPack>
						<TotalSticks>240</TotalSticks>
						<Price>99.99</Price>
					</Transactions>
				</TransactionDocument>
			</Schedule>
		</SchTransaction>
		<SchUnaffixedStampReport>
			<BegInventory>
				<TotalInventoryCount>354</TotalInventoryCount>
				<TotalInventoryGrossValue>999.99</TotalInventoryGrossValue>
				<Details>
					<TaxJurisdiction>WI</TaxJurisdiction>
					<Attribute>a</Attribute>
					<StampUOM>10</StampUOM>
					<Count>354</Count>
					<GrossValue>999.99</GrossValue>
				</Details>
			</BegInventory>
			<TotalPurchaseCount>10</TotalPurchaseCount>
			<TotalPurchaseGrossValue>9999.99</TotalPurchaseGrossValue>
			<Purchases>
				<DateReceived>2018-02-01</DateReceived>
				<PurchaseOrderNumber>P0123</PurchaseOrderNumber>
				<PurchaseOrderDetails>
					<RollID>321A</RollID>
					<Stamps>
						<TaxJurisdiction>WI</TaxJurisdiction>
						<Attribute>a</Attribute>
						<StampUOM>20</StampUOM>
						<Count>10</Count>
						<GrossValue>999.99</GrossValue>
					</Stamps>
				</PurchaseOrderDetails>
			</Purchases>
			<TotalAdjustmentCount>240</TotalAdjustmentCount>
			<TotalAdjustmentGrossValue>9999.99</TotalAdjustmentGrossValue>
			<Adjustments>
				<Date>2018-02-02</Date>
				<TypeOfAdjustment>Shrinkage</TypeOfAdjustment>
				<Explanation>Explanation here</Explanation>
				<Stamps>
					<TaxJurisdiction>WI</TaxJurisdiction>
					<Attribute>Some attribute</Attribute>
					<StampUOM>25</StampUOM>
					<Count>100</Count>
					<GrossValue>999.99</GrossValue>
				</Stamps>
			</Adjustments>
			<EndInventory>
				<TotalInventoryCount>20</TotalInventoryCount>
				<TotalInventoryGrossValue>99.99</TotalInventoryGrossValue>
				<Details>
					<TaxJurisdiction>WI</TaxJurisdiction>
					<Attribute>a</Attribute>
					<StampUOM>20</StampUOM>
					<Count>20</Count>
					<GrossValue>99.99</GrossValue>
				</Details>
			</EndInventory>
			<StampsAffixed>
				<TotalInventoryCount>15</TotalInventoryCount>
				<TotalInventoryGrossValue>9999.99</TotalInventoryGrossValue>
				<Details>
					<TaxJurisdiction>WI</TaxJurisdiction>
					<Attribute>a</Attribute>
					<StampUOM>20</StampUOM>
					<Count>14</Count>
					<GrossValue>9999.99</GrossValue>
				</Details>
			</StampsAffixed>
		</SchUnaffixedStampReport>
		<SchPack>
			<BegInventory>
				<ReportingJurisdictionStickCnt>450</ReportingJurisdictionStickCnt>
				<OtherJurisdictionStickCount>150</OtherJurisdictionStickCount>
				<Details>
					<FedDesc>Cigarette</FedDesc>
					<MSAStatus>NSM</MSAStatus>
					<TaxJurisdiction>WI</TaxJurisdiction>
					<UPCNumber/>
					<UPCUOM>PAK</UPCUOM>
					<Manufacturer>a</Manufacturer>
					<ManufacturerEIN>000000006</ManufacturerEIN>
					<BrandFamily>Some Brand</BrandFamily>
					<Quantity>45</Quantity>
					<SticksPerPack>10</SticksPerPack>
					<TotalSticks>450</TotalSticks>
				</Details>
			</BegInventory>
			<InventoryAdj>
				<ReportingJurisdictionStickCnt>120</ReportingJurisdictionStickCnt>
				<OtherJurisdictionStickCount>100</OtherJurisdictionStickCount>
				<Details>
					<FedDesc>Cigarette</FedDesc>
					<MSAStatus>SPM</MSAStatus>
					<TaxJurisdiction>WI</TaxJurisdiction>
					<UPCNumber/>
					<UPCUOM>CSE</UPCUOM>
					<Manufacturer>Some Manufacturer</Manufacturer>
					<ManufacturerEIN>000000004</ManufacturerEIN>
					<BrandFamily>Unbrand</BrandFamily>
					<Quantity>12</Quantity>
					<SticksPerPack>10</SticksPerPack>
					<TotalSticks>120</TotalSticks>
					<TypeOfAdj>Timing</TypeOfAdj>
				</Details>
			</InventoryAdj>
			<EndingInventory>
				<ReportingJurisdictionStickCnt>100</ReportingJurisdictionStickCnt>
				<OtherJurisdictionStickCount>20</OtherJurisdictionStickCount>
				<Details>
					<FedDesc>Cigarette</FedDesc>
					<MSAStatus>NSM</MSAStatus>
					<TaxJurisdiction>WI</TaxJurisdiction>
					<UPCNumber/>
					<UPCUOM>CAR</UPCUOM>
					<Manufacturer>This Manufacturer</Manufacturer>
					<ManufacturerEIN>000000005</ManufacturerEIN>
					<BrandFamily>That Brand</BrandFamily>
					<Quantity>12</Quantity>
					<SticksPerPack>10</SticksPerPack>
					<TotalSticks>120</TotalSticks>
				</Details>
			</EndingInventory>
		</SchPack>
	</ReturnDataState>
</ReturnState>
