Form Cg-21 - Out-Of-State Cigarette Wholesaler'S Monthly Tax Report Form - State Of Kansas

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STATE OF KANSAS
DEPARTMENT OF REVENUE
Customer Relations
TOLL FREE 1-877-526-7738
Licensee Segment
(785) 368-8222
Kansas Department of Revenue
FAX (785) 296-2073
915 SW Harrison St
Hearing Impaired TTY (785) 296-6461
Topeka, Kansas 66625-2007
Division of Taxation
SCHEDULE E
OUT-OF-STATE CIGARETTE WHOLESALER'S MONTHLY TAX REPORT
(20 Cigarettes Per Pack)
Name
Address
Month of
,
Signature of Dealer
From
To
Number in Packs
INVENTORY FIRST OF MONTH
1. Kansas stamped cigarettes ................................................................
2. Kansas decal stamps unaffixed .........................................................
3. Kansas fuson stamps unaffixed .........................................................
4. Kansas meter units unaffixed
X 10 =
5. Total beginning inventory (add lines 1, 2, 3 & 4)..............................
PURCHASES DURING MONTH
6. Kansas decal stamps .........................................................................
7. Kansas fuson stamps.........................................................................
8. Kansas meter units
X 10 =
9. Total purchases (add lines 6, 7 & 8)..................................................
10. TOTAL TAX CREDIT AVAILABLE (add lines 5 & 9)...............
INVENTORY END OF MONTH
11. Kansas stamped cigarettes ................................................................
12. Kansas decal stamps unaffixed .........................................................
13. Kansas fuson stamps unaffixed .........................................................
14. Kansas meter units unaffixed
X 10
15. Total ending inventory (add lines 11, 12, 13 & 14) ...........................
16. TAX CREDIT USED (line 10 minus line 15) .................................
*17. STAMPED CIGARETTES SOLD INTO THE STATE OF KANSAS (attach Schedule F & F1)
*Line 17 should be the same as Line 16. If not, explain the difference.
This report with all supporting schedules is due by the 10th of the month following the report month.
CG-21 (Rev. 7/00)

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