Free CG-30.1-X - New York

New York State Department of Taxation and Finance

Additional Information Regarding Brands Sold in New York State
You must have previously filed Form CG-30, Certification of Tobacco Master Settlement Agreement Status, with the Tax Department and Attorney General of New York State (NYS) to be eligible to use this form. Attach additional sheets if necessary.
Legal name of manufacturer Date

CG-30.1-X
(5/09)

Federal employer identification number (EIN)

As required by NYS Tax Law section 480-b and 480-c, every tobacco product manufacturer must annually file Form CG-30, Certification of Tobacco Master Settlement Agreement Status, and list each cigarette and roll-your-own (RYO) tobacco brand sold for consumption in NYS from January 1 of the prior calendar year until the date of the annual certification. If you intend to add brands after the date the current annual certification was filed, you must complete and file Form CG-30.1-X and an amended Form CG-30 before making the first sale of these brands in NYS. Also submit a copy of Form CG-30 and Form CG-30.1, Information Regarding Brands Sold in New York State, which you previously submitted for this current certification period. The following is a list of additional brands to be sold for consumption in NYS by the above manufacturer. Page Additional brand names*
RYO New

of

Date of intended first sale in NYS

* Be sure the complete brand name(s) of the cigarettes or RYO tobacco is listed, including the following (attach additional sheets if necessary):
·filteredorunfiltered ·descriptiveinformationsuchasmentholorslim ·size(forexample,regular,king,100's,etc.) ·ifbrandnameisanRYO,markanX in the RYO box ·ifbrandnameisanewbrand(s)ofcigarettesnotincludedonyourprior certification,markanX in the New box ·otherinformationasnecessarytoidentifytheproduct

Note: You must attach this Form CG-30.1-X to the amended Form CG-30 along with copies of the original Form CG-30 and Form CG-30.1 on file with the Tax Department and Attorney General of NYS for the current certification period. I certify that I have filed Form CG-30 and Form CG-30.1 and that the above list represents additional brands to be sold for consumption in NYS from the date(s) specified.
Authorizedsignature Printed name Title Date