Form Cg-114 - Claim For Redemption/refund Of Cigarette Tax Stamps And Prepaid Sales Tax
Download a blank fillable Form Cg-114 - Claim For Redemption/refund Of Cigarette Tax Stamps And Prepaid Sales Tax in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Cg-114 - Claim For Redemption/refund Of Cigarette Tax Stamps And Prepaid Sales Tax with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2New York State Department of Taxation and Finance
CG-114
Transaction and Transfer Tax Bureau — FACCTS/Cigarette Tax
(8/97)
Claim for Redemption/Refund of Cigarette Tax Stamps
and Prepaid Sales Tax
(Sections 476 and 1121 of the Tax Law)
Name of claimant
Type of business - Wholesaler, retailer, etc.
Federal identification number
Street address
Agent’s license number
City
State
ZIP code
Social security number
NYS Sales tax identification number
Part I. Claim for Redemption for Unused or Damaged Cigarette Tax Stamps and Prepaid Sales Tax
(see note on back)
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Column H
Date of
Prepaid Sales
Cig Tax Refund
Commission
Cig Tax Refund
Prepaid Sales Tax
purchase
Cig Tax Stamp
Tax Per Pack
Number of
Requested
Commission
Amount
Less Commission
Refund Requested
Denomination
(see instructions)
Stamps
(A
C)
Rate
(D
E)
(D
F)
(B x C)
28¢
28¢ joint
56¢
56¢
56¢ joint
56¢ joint
70¢
70¢
70¢ joint
70¢ joint
Total
1. Total cigarette tax refund less commission (Column G) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Total prepaid sales tax refund (Column H). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Total refund requested
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(add lines 1 and 2)
Part II. Claim for Refund for Stamps Affixed to Packages of Cigarettes and Prepaid Sales Tax
(see note on back)
Column A
Column B
Column C
Column D
Column E
Column F
Column G
Column H
Date of
Prepaid Sales
Cig Tax Refund
Commission
Cig Tax Refund
Prepaid Sales Tax
purchase
Cig Tax Stamp
Tax Per Pack
Number of
Requested
Commission
Amount
Less Commission
Refund Requested
Denomination
(see instructions)
Stamps
(A
C)
Rate
(D
E)
(D
F)
(B x C)
28¢
28¢ joint
56¢
56¢
56¢ joint
56¢ joint
70¢
70¢
70¢ joint
70¢ joint
Total
1. Total cigarette tax refund less commission (Column G) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Total prepaid sales tax refund (Column H). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Total refund requested
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(add lines 1 and 2)
Certification:
Caution: Read this claim before signing. Presenting a false or fraudulent claim constitutes a felony. (Penal Law, section 175.35).
I hereby certify that the foregoing statement is true and correct in every particular; that the cigarette tax stamps described above were purchased
by the claimant herein for the purpose of affixing them to cigarette packages as required by law; that they are no longer required by the claimant for such
purpose or they are so damaged as to be unfit for use; that no claim has been hereto presented for the redemption of any of the above described stamps;
that no credit for the prepaid sales tax has been heretofore claimed on a sales tax return, and that the refund of the net purchase price of such stamps,
including the prepaid sales tax, claimed herein is just and lawfully due from the state of New York.
Signed in
(County)
(State)
(Signature of owner/officer)
this
day of
,19
(Title)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial