Form Cg-100-L - Cigarette Agent / Wholesaler-Lessor Identification
ADVERTISEMENT
1CG-100-L
New York State Department of Taxation and Finance
Cigarette Agent / Wholesaler-Lessor Identification
(1/02)
Article 20 of the Tax Law
Submit a separate form for each location.
Section I should be completed by the applicant for a license.
Section II must be completed by the lessor of the premises where the cigarette business will be conducted.
This form must be filed with the Application for License as a Cigarette Agent or Agent / Wholesaler (Form CG-100-A or CG-100-W).
I.
Name and address of applicant for license
Legal name
Applicant’s federal employer identification number (FEIN)
Address of leased premises
City
State
ZIP code
II. 1. Name and address of lessor
Legal name
FEIN or social security number
Address
City
State
ZIP code
2. Type of organization of lessor
(check only one box).
Individual
Partnership
Corporation
LLC
LLP
Other (specify)
Joint Tenants
Tenants-in-Common
If the lessor organization is other than an individual, attach a schedule indicating the name, address and identification
number of any controlling person(s). For the definition of controlling person, see the instructions on back.
3. Has the lessor, or any controlling person of the lessor, ever been licensed under the NYS Cigarette Tax Law (Article 20)?
Yes
No
If Yes, indicate person licensed, dates, and license number.
4. Has the lessor, or any controlling person of the lessor, ever been a controlling person of any entity licensed under the NYS Cigarette
Tax Law (Article 20)?
Yes
No
If Yes, indicate name of controlling person and name of entity licensed.
5. Does the lessor have any financial interest, other than rental payments, in the applicant’s business?
Yes
No
If Yes, give brief explanation below.
6. Does the lessor own or lease the premises?
Own
Lease
If leased, provide the name of the person from whom you lease the premises.
Date
Signature of lessor
Title of lessor
The person signing this form must be the same person who signed the lease. If the signator is different, please explain.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Cg-100-v - Application For License As A Wholesale Cigarette Dealer Who Only Operates Vending Machines
Financial
Form Cg-100-w - Application For License As A Wholesale Cigarette Dealer Other Than Those Who Only Operate Vending Machines
Financial
Form Cg-15 - Unstamped Cigarette Packs Received Per Manufacturer And Kansas Stamps Affixed To Packs (out-of-state Distributors)
Financial
Related Categories
Parent category: Financial