Instructions For Form Cg-100-P - Personal Questionnaire 2006
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2CG-100-P-I
New York State Department of Taxation and Finance
Instructions for Form CG-100-P
(3/06)
Personal Questionnaire
Article 20 of Tax Law
Who must file this form
periods of limitation, power of attorney, audit method
election agreements, consents fixing tax (for example,
A separate Personal Questionnaire is required for each
Statement of Proposed Audit Adjustment), installment
controlling person of an applicant for license as a cigarette
payment agreements;
agent, a cigarette wholesaler, a tobacco products wholesaler,
• responsibility for handling business receipts;
or for appointment as a tobacco products distributor.
• authority to negotiate loans/borrow money for business or
For purposes of this form, the term controlling person means
guaranteeing of business loans;
any person who is an officer, director, or partner (or, in the
• authority to hire or fire employees.
case of a limited liability company, an officer, member, or a
person having, with respect to such limited liability company,
Item 5 — List any aliases or names (including maiden) used
authority analogous to that of a corporate officer or director)
or formerly used by the person listed in item 2.
of an applicant for an agent or wholesale dealer license
under Article 20 of the Tax Law; or, if the applicant is a
Item 6 — Provide all required information for the person
corporation, a shareholder who directly or indirectly owns
listed in item 2.
more than 10% of the number of shares of voting stock of
Item 7 — List name, address, telephone number, and social
such corporation. It also includes persons who do or will
security number of spouse (if married or separated).
exercise authority within the business comparable to the
authority normally exercised by corporate officers, regardless
Item 8 — Complete all the required information regarding
of the form of business organization or lack of actual title.
your present and previous employment for the past 10 years.
Personal Questionnaires may be submitted separately
Item 9 — If you are planning on taking an active role in the
from the application for registration if the controlling person
operation of the applicant listed in item 1, provide a schedule
desires confidentiality.
of the hours that will be devoted to the operation of the
Read the instructions carefully. An application for a
business.
license cannot be processed until all of the required
Item 10 — If Yes, complete all of the required boxes for each
attachments are submitted.
entity. Attach additional sheets if necessary.
Item 1 — Enter the exact legal name and federal employer
Item 11 — Are you, or have you been, an owner of 10%
identification number (FEIN) as listed on the application for
or more of the voting stock of any other corporation; or an
license.
officer, director, or partner of any other business other than
Item 2 — Enter your name, social security number, date of
the one for which you are applying? If Yes, complete all of
birth, telephone number, street address of current residence
the required boxes for each entity. Attach additional sheets if
(PO box is not acceptable), and number of years at that
necessary.
address.
Item 12 — If Yes, provide the name and address of applicant,
Item 3 — List all other addresses where you have lived
date of filing, and disposition. If the application was refused,
during the past 10 years.
suspended, or revoked, provide a complete description of
Item 4(a) — Enter your title(s), if any, with the applicant listed
the events surrounding the refusal, suspension, revocation,
in item 1.
and/or cancellation.
Item 4(c) — Check all boxes that identify your business
Item 13 — Check Yes only if you filed both a New York State
activities.
and federal personal income tax return for each of the past
five years. If you check No, enclose a copy of your federal
List any other duties that you have regarding your
return for any year that you did not file a New York State
participation in significant business decisions, such as:
return. If you were not required to file either a New York
• supervising the preparation of tax returns and insuring
State or a federal personal income tax return, enclose an
remittance of tax;
explanation of the reason that no return was due and how
• authority for management of business;
you supported yourself for the years you were not required to
• knowledge and control over financial affairs;
file.
• authority to pay or direct payment of creditors;
Item 15(b) — Include crimes committed in New York State
• responsibility for maintaining/managing business records;
and other states or countries. You may exclude traffic
violations of the vehicle and traffic laws.
• the authority to deal with the business’ tax accountant or
tax counsel;
Item 16(b) — Include crimes pending in New York State and
• authority to negotiate with the Tax Department or to sign
other states or countries. You may exclude traffic violations of
any of the following: tax returns, consents extending
the vehicle and traffic laws.
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