Form Cg-15 - Cigarette Use Tax Return - New York State Department Of Taxation And Finance

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New York State Department of Taxation and Finance
CG-15
For office use only
Cigarette Use Tax Return
(9/04)
Tax Law — Article 20
This return must be filed within 24 hours after the tax liability is incurred.
You may also have to pay a sales and use tax on your cigarette purchases. The sales and use tax is paid with
your personal income tax return or by filing Form ST-140, Individual Purchaser’s Report of Sales and Use Tax.
Generally, the sales and use tax is due on April 15 (see instructions) .
Read the instructions carefully, and attach photocopies of the purchase invoices to this return.
Keep a copy of Form CG-15 and a copy of either your personal income tax return or form ST-140 for your records.
Name
Federal identification number
Social security number
Street address
City
State
ZIP code
Computation of cigarette use tax — Complete Schedule A and/or Schedule B as applicable
(see instructions).
New York State
1 Enter total number of packages of cigarettes
1
(from Schedule A, Column H) ...................................................................
2 New York State cigarette use tax rate
.........................................................
2
$1.50
(per standard package of 20 cigarettes)
3 New York State cigarette use tax due
..............................................................................
3
(multiply line 1 by line 2)
New York City
4 Enter total number of packages of cigarettes
4
(from Schedule B, Column H) ..................
5 New York City cigarette use tax rate
(per standard package of 20 cigarettes)
...............
5
$1.50
6 New York City cigarette use tax due
.................................................................................
6
(multiply line 4 by line 5)
7 Total New York State and New York City cigarette use tax due
................................................
7
(add lines 3 and 6)
8 Penalty
.......................................................................................................................................
8
(see instructions)
9 Interest
.......................................................................................................................................
9
(see instructions)
10 Total amount due
................................................................................................................. 10
(add lines 7, 8, and 9)
11 Total amount enclosed
.......... 11
(attach your check or money order payable to Commissioner of Taxation and Finance)
Schedule A — New York State
Complete Schedule A if you purchased or otherwise acquired cigarettes for use in this state in packages that do not have the New York State
tax stamp affixed. Attach additional sheets if necessary.
Column
Column
Column
Column
Column
Column
Column
Column
A
B
C
D
E
F
G
H
Date
Name and address of supplier
Brand name
Mail order
Nature
Number of
Number of
Total
of use
standard
nonstandard
packages
of use
(mark an X in the
packages
packages
appropriate box)
(self-use,
(add columns
gift, etc.)
F and G)
(see Conversion
(20 cigarettes
per pack)
calculation on
page 2)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Total
..................................................................................................................................................
(enter here and on line 1 above)
Certification: I hereby certify to the best of my knowledge and belief that this is a true, correct, and complete return.
Authorized signature
Official title
Date
Signature of individual or name of firm preparing this return
Preparer’s address
Date
Mail to: NYS Tax Department, Cigarette Tax, TTTB FACCTS - R & B Unit, Building 8, W A Harriman Campus, Albany NY 12227

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