Form Cg-30 - Sales Of Non-Participating Manufacturer (Npm) Cigarettes In Kansas Schedule Msa-Cig-1 Page 2
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1
2INSTRUCTIONS FOR SCHEDULE MSA-CIG-1
As part of the Master Settlement Agreement between certain cigarette
Column D: Enter the full name and address (including street, city, state
manufacturers and the State of Kansas, the Department of Revenue is
and zip code) of the NPM who manufactured the cigarette brand sold.
required to compile information about cigarettes and roll-your-own (RYO)
tobacco sold in Kansas that is manufactured or imported by manufacturers
Column E: Enter the full name and address (including street, city, state,
who do not participate in the Master Settlement Agreement (Non-
and zip code) of the supplier from whom you originally purchased the
Participating Manufacturers). The Department of Revenue will provide this
cigarette brand sold if different from the NPM identified in Column D.
information to the Kansas Attorney General for use in enforcing the law.
Column F: Enter the full name and address (including street, city, state
Complete this schedule and submit it on or before the 10th day of each
and zip code) of the first importer of any cigarette brand manufactured
month, along with your monthly excise tax report, if you are a licensed
outside of the United States.
cigarette wholesale dealer.
Completion of Schedule:
ƒ
Complete this schedule as required in full, even if you had no activity
Use supplemental schedules if necessary. You may photocopy
during the filing period. If you had no activity, please check the designated
this schedule if you require additional space.
ƒ
box on the schedule.
Sign and date the schedule declaring that the information listed is
true and correct.
ƒ
Preparation of Schedule:
Print your name and title.
ƒ
ƒ
Check the box indicating whether this is an “Original Report” or an
Enter the page number and total number of pages included in the
“Amended Report.”
completion of this schedule.
ƒ
ƒ
Enter your full name and address (including street, city, state, and
Retain a copy of this schedule for your files.
ƒ
zip code).
Include this completed schedule with your monthly excise tax
ƒ
Enter your Kansas wholesale dealer license number.
report and mail to:
ƒ
Enter the month and year covered by this report.
Miscellaneous Tax – Customer Relations
Kansas Department of Revenue
Column A: Enter the full brand family name of the NPM cigarette product
915 SW Harrison St.
sold. Do not abbreviate. Do not break down into sub-categories, such as
Topeka, Kansas 66612-1588
regular, menthol, light, etc. Visit for a current list of
This schedule is for reporting purposes only. It is not used for the calculation
manufacturers and brands certified for sale in Kansas.
of tax.
Column B: Enter the number of 20-cigarette packs sold in Kansas during
For assistance in completing this schedule, please contact the Kansas
the reporting month. List only cigarette packs to which you affixed the
Department of Revenue at 785-368-8222.
Kansas excise tax stamp. Do not list cigarette packs that were purchased
with the Kansas excise tax stamp already affixed.
FAILURE TO FILE YOUR MONTHLY REPORT AS REQUIRED BY LAW
Column C: Enter the number of 25-cigarette packs sold in Kansas during
MAY RESULT IN THE SUSPENSION OR REVOCATION OF YOUR
WHOLESALE DEALER’S LICENSE FOR A PERIOD UP TO ONE YEAR
the reporting month. List only cigarette packs to which you affixed the
AND A MAXIMUM
ADMINISTRATIVE FINE OF $1,000 FOR EACH
Kansas excise tax stamp. Do not list cigarette packs that were purchased
VIOLATION.
with the Kansas excise tax stamp already affixed.
You may obtain additional copies of this schedule by visiting the Department of Revenue’s website at:
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