Form Cg-5 - Nonresident Agent Cigarette Tax Report
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1
2CG-5
New York State Department of Taxation and Finance
Nonresident Agent Cigarette Tax Report
(3/14)
Transaction Desk Audit Bureau FACCTS/Cigarette Tax
(To be completed by agents located outside New York State) File in duplicate.
File this report each month on or before the 15th day of the following month. Keep a copy for your records.
Note: You must have approval from the New York State Tax Department to file for any period other than a calendar month.
If approval was granted, enter your filing period here:
Enter name and address of agent if not preprinted:
Period covered by this report:
Change of business information -
Month:
Year:
If there have been any changes in
your business name, ID number,
Federal employer identification number (FEIN)
mailing address, business
address, telephone number
or owner/officer information,
Agent’s license number
complete Form DTF-95,
Business Tax Account Update.
NYS sales tax identification number
To change only your address,
use Form DTF-96, Report of
Address Change for Business Tax
Social security number
Accounts. If you need a form, see
Need help? on the back.
Part I — Report of NYS stamped cigarettes
Enter the number of cigarettes (sticks) in the appropriate column(s)
Other
(indicate pack size)
20 packs
25 packs
packs
packs
packs
1
Beginning inventory ..........................................
1
2
2
Number of cigarettes stamped .........................
3
Number of cigarettes received with New York State
tax stamps affixed
3
(from Form CG‑5.1, Schedule A)
4
Total
4
(add lines 1, 2, and 3)
5
Ending inventory ...............................................
5
6
Number of stamped cigarettes sold
(subtract
6
..............................................
line 5 from line 4)
Part II — Sales of unstamped cigarettes
Enter the number of cigarettes (sticks) in the appropriate column(s)
Other
(indicate pack size)
20 packs
25 packs
packs
packs
packs
7
Sales inside New York State
(from
.................................
7
Form CG‑5.2, Schedule C)
Part III — Report of NYS cigarette tax stamps
(Use quantity and not face value of stamps)
Tax stamps for packs of
Tax stamps for packs of
20 cigarettes
21 - 25 cigarettes
state only
joint-state/city
state only
joint-state/city
8
Inventory of unaffixed stamps at
beginning of the month ..............................
8
9
Stamps purchased during the month ............
9
10
10
Total
....................................
(add lines 8 and 9)
11
Inventory of unaffixed stamps at end of
the month ...................................................
11
12
Stamps used this month
(subtract line 11
..................................................
12
from line 10)
13
Stamps required to be affixed to packs of
13
cigarettes ...................................................
14
Difference
(subtract line 13 from line 12 and
14
....................................
attach an explanation)
I hereby certify that this is a true and complete report to the best of my knowledge and belief.
Printed name of authorized person
Signature of authorized person
Official title
Authorized
person
E-mail address of authorized person
Telephone number
Date
(
)
Firm’s name
Firm’s EIN
Preparer’s PTIN or SSN
Paid
(or yours if self‑employed)
preparer
Signature of individual preparing this claim
Address
City
State
ZIP code
use
only
E-mail address of individual preparing this claim
Telephone number
Preparer’s NYTPRIN
Date
(see instr.)
(
)
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