KANSAS DEPARTMENT OF REVENUE
REQUEST FOR REFUND FOR STAMPED UNSALEABLE CIGARETTES
RETURNED TO MANUFACTURER
SCHEDULE D
:
#:
Name of Wholesaler
Wholesaler License
The undersigned states that these stamped unsaleable cigarettes were returned by
(Name of Wholesaler)
to the Manufacturer, and that all packages of cigarettes
(Address of Wholesaler)
had Kansas indicia affixed.
Less .55%
Number of Packs
Tax Rate
Gross Tax Amount
Net Tax Paid
Wholesaler Discount
1
2
3
4
5
6
7
8
9
10
11
Grand total of tax paid (add lines 1 through 10)
12
Less: .55% Processing Fee (line 11 x .0055)
13
Net refund (line 11 minus line 12)
states, as supported by their affidavit dated
(Manufacturer)
, that these cigarettes will not be reshipped into Kansas and that the indicia
affixed thereto has been destroyed.
(Signature of Wholesaler)
In-State: Complete this form if you return Kansas stamped cigarettes to the manufacturer. You may use one CG-47 for more than one
affidavit however, each manufacturer should be on a separate CG-47. You must submit an affidavit from each manufacturer stating the
number of cigarettes that were returned and destroyed. Line 12 of the CG-47 is per K.S.A. 79-3312.
Out-of-State: Complete this form if you return Kansas stamped cigarettes to the manufacturer. Each manufacturer should be on a
separate CG-47. You must submit an affidavit from each manufacturer stating the number of cigarettes that were returned and
destroyed. You may use one CG-47 for more than one affidavit. Line 12 of the CG-47 is per K.S.A. 79-3312.
Submit reports to the Kansas Department of Revenue by the 25
th
day of the month following the reporting month to: Cigarette
Tobacco, 915 SW Harrison St., Topeka, KS 66612-1588.
If you have any questions or need additional assistance, please contact our office at 785-368-8222, choose option 5 followed by
option 4 from 8 a.m. to 4:45 p.m., Monday through Friday, and email us at: kdor_cigtob@ks.gov, or if needing forms visit our website
at:
http://www.ksrevenue.org/bustaxtypescig.html
.
CG-47 Rev. 7-17
KANSAS DEPARTMENT OF REVENUE
REQUEST FOR REFUND FOR STAMPED UNSALEABLE CIGARETTES
RETURNED TO MANUFACTURER
SCHEDULE D
:
#:
Name of Wholesaler
Wholesaler License
The undersigned states that these stamped unsaleable cigarettes were returned by
(Name of Wholesaler)
to the Manufacturer, and that all packages of cigarettes
(Address of Wholesaler)
had Kansas indicia affixed.
Less .55%
Number of Packs
Tax Rate
Gross Tax Amount
Net Tax Paid
Wholesaler Discount
1
2
3
4
5
6
7
8
9
10
11
Grand total of tax paid (add lines 1 through 10)
12
Less: .55% Processing Fee (line 11 x .0055)
13
Net refund (line 11 minus line 12)
states, as supported by their affidavit dated
(Manufacturer)
, that these cigarettes will not be reshipped into Kansas and that the indicia
affixed thereto has been destroyed.
(Signature of Wholesaler)
In-State: Complete this form if you return Kansas stamped cigarettes to the manufacturer. You may use one CG-47 for more than one
affidavit however, each manufacturer should be on a separate CG-47. You must submit an affidavit from each manufacturer stating the
number of cigarettes that were returned and destroyed. Line 12 of the CG-47 is per K.S.A. 79-3312.
Out-of-State: Complete this form if you return Kansas stamped cigarettes to the manufacturer. Each manufacturer should be on a
separate CG-47. You must submit an affidavit from each manufacturer stating the number of cigarettes that were returned and
destroyed. You may use one CG-47 for more than one affidavit. Line 12 of the CG-47 is per K.S.A. 79-3312.
Submit reports to the Kansas Department of Revenue by the 25
th
day of the month following the reporting month to: Cigarette
Tobacco, 915 SW Harrison St., Topeka, KS 66612-1588.
If you have any questions or need additional assistance, please contact our office at 785-368-8222, choose option 5 followed by
option 4 from 8 a.m. to 4:45 p.m., Monday through Friday, and email us at: kdor_cigtob@ks.gov, or if needing forms visit our website
at:
http://www.ksrevenue.org/bustaxtypescig.html
.
CG-47 Rev. 7-17
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