Form CG-80 "Application for Registration as a Chain Store" - New York

What Is Form CG-80?

This is a legal form that was released by the New York State Department of Taxation and Finance - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2004;
  • The latest edition provided by the New York State Department of Taxation and Finance;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form CG-80 by clicking the link below or browse more documents and templates provided by the New York State Department of Taxation and Finance.

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Download Form CG-80 "Application for Registration as a Chain Store" - New York

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For office use only
CG-80
New York State Department of Taxation and Finance
Application for Registration
(11/04)
as a Chain Store
Pursuant to Tax Law Article 20-A, Cigarette Marketing Standards Act
A chain store registration is granted exclusively to the applicant and is not transferable.
Read Form CG-80-I, Instructions for Form CG-80, carefully before completing this application. Attach additional sheets as necessary to fully
answer all questions. Once registration is granted, the certificate of chain store registration must be publicly displayed at your place of
business (other than individual vending machines). Keep a copy for your records.
Mark an X in the appropriate box for this application.
(For definitions and information required to be submitted with this form, see Definitions and
Documentation requirements on Form CG-80- I .)
Registration fee
Cooperative member ....................................................................................................................................................
$300*
Name of cooperative
FEIN of cooperative
Franchisee ....................................................................................................................................................................
$300*
Name of franchisor
FEIN of franchisor
Vending machine operator (must have 15 or more marketing locations within NYS) ...................................................
$250*
NYS wholesale dealer license number
CWV –
Large volume outlet operator (one fee based per operator, not per outlet) .................................................................
$300*
Business with 15 or more retail outlets ......................................................................................................................
$300*
Currently licensed (reporting additional registered locations or vending machines) .....................................................
No fee
*If the registration fee has been paid within the preceding 12 months, the registration fee is $200.
Print or type
1. Legal name
2. Trade name/dba
(if different from above)
3. Address of principal place of business
(number and street; see instructions)
City
State
ZIP code
4. County
(principal place of business)
5. Telephone number of principal place of business
6. Date business began or
7. FEIN
8. Other FEIN, if any
will begin in New York State
(
)
/
/
9. Type of organization
(mark an X in one or more boxes)
Sole proprietor
Partnership
Corporation
:
Other
(specify)
10. Mailing address
City
State
ZIP code
(if different from business address)
For office use only
CG-80
New York State Department of Taxation and Finance
Application for Registration
(11/04)
as a Chain Store
Pursuant to Tax Law Article 20-A, Cigarette Marketing Standards Act
A chain store registration is granted exclusively to the applicant and is not transferable.
Read Form CG-80-I, Instructions for Form CG-80, carefully before completing this application. Attach additional sheets as necessary to fully
answer all questions. Once registration is granted, the certificate of chain store registration must be publicly displayed at your place of
business (other than individual vending machines). Keep a copy for your records.
Mark an X in the appropriate box for this application.
(For definitions and information required to be submitted with this form, see Definitions and
Documentation requirements on Form CG-80- I .)
Registration fee
Cooperative member ....................................................................................................................................................
$300*
Name of cooperative
FEIN of cooperative
Franchisee ....................................................................................................................................................................
$300*
Name of franchisor
FEIN of franchisor
Vending machine operator (must have 15 or more marketing locations within NYS) ...................................................
$250*
NYS wholesale dealer license number
CWV –
Large volume outlet operator (one fee based per operator, not per outlet) .................................................................
$300*
Business with 15 or more retail outlets ......................................................................................................................
$300*
Currently licensed (reporting additional registered locations or vending machines) .....................................................
No fee
*If the registration fee has been paid within the preceding 12 months, the registration fee is $200.
Print or type
1. Legal name
2. Trade name/dba
(if different from above)
3. Address of principal place of business
(number and street; see instructions)
City
State
ZIP code
4. County
(principal place of business)
5. Telephone number of principal place of business
6. Date business began or
7. FEIN
8. Other FEIN, if any
will begin in New York State
(
)
/
/
9. Type of organization
(mark an X in one or more boxes)
Sole proprietor
Partnership
Corporation
:
Other
(specify)
10. Mailing address
City
State
ZIP code
(if different from business address)
Page 2 of 4 CG-80 (11/04)
11. Mark an X in the appropriate box to indicate whether your business is currently
registered or has tax accounts with New York State for the following taxes:
If Yes, enter identification number below.
A. Cigarette tax/tobacco products tax (Article 20) ......................
Yes
No
B. Sales tax
.................................
Yes
No
(must be registered; see page 4)
C. Corporation tax .......................................................................
Yes
No
D. Withholding tax .......................................................................
Yes
No
E. Other taxes
......................................................
Yes
No
(specify below)
Specify type(s) of taxes:
12. List officers, directors, and certain shareholders, partners, or sole proprietor.
(See instructions; attach additional sheets if necessary.)
Name
Social security number
Percent of ownership
Home address
Title
(number and street)
City
State
ZIP code
Telephone number
(
)
Name
Social security number
Percent of ownership
Home address
Title
(number and street)
City
State
ZIP code
Telephone number
(
)
Name
Social security number
Percent of ownership
Home address
Title
(number and street)
City
State
ZIP code
Telephone number
(
)
Name
Social security number
Percent of ownership
Home address
Title
(number and street)
City
State
ZIP code
Telephone number
(
)
13. Enter the percentage of voting stock held by all other owners. (The total percentage of voting stock in items 12 and 13
must equal 100%) ...................................................................................................................................................................
%
14. During the last 5 years, has the applicant or any person listed in item 12:
— owned or controlled, directly or indirectly, more than 10% of the shares of stock (25% or more if four or fewer
shareholders own or control voting stock of such business) entitling the holder to vote for directors or trustees
of a business other than the applicant, or
— been an officer, director, or partner of a business other than the applicant’s business? ................................................
Yes
No
If Yes, complete below. Attach additional sheets if necessary.
Name of other business
FEIN
Address
City
State
ZIP code
(number and street)
Name of person or applicant
Name of other business
FEIN
Address
City
State
ZIP code
(number and street)
Name of person or applicant
Name of other business
FEIN
Address
City
State
ZIP code
(number and street)
Name of person or applicant
CG-80 (11/04) Page 3 of 4
15. Does the applicant, anyone listed in item 12, or any business listed in item 14 (at the time anyone listed in
item 12 was so connected with the business) have any outstanding liability for New York State tax,
New York City income or nonresident earnings tax, or city of Yonkers surcharge or nonresident earnings tax? .......
Yes
No
If Yes, complete below. Attach additional sheets if necessary.
Name of applicant, person, or business
Type of tax
Amount due
Assessment number
Assessment date
/
/
/
/
/
/
/
/
/
/
/
/
/
/
16. In the past five years, was the applicant, anyone listed in item 12, or any business listed in item 14 (at the time
anyone listed in item 12 was so connected with the business) convicted of any crimes? (see instructions) ............
Yes
No
If Yes, complete below. Attach additional sheets if necessary.
Name of applicant, person, or business
City and state of arrest
Date of conviction
Court of conviction
Statute section convicted of violating Disposition (fine, imprisonment, etc.)
/
/
Detailed description of charges
17. In the past five years, has the applicant, anyone listed in item 12, or any business listed in item 14 (while anyone
listed in item 12 was so connected with that business) had a license as a cigarette wholesale dealer or agent
or a registration as a chain store canceled suspended, or denied? ...........................................................................
Yes
No
If Yes, complete below. Attach additional sheets if necessary.
Name of applicant, person, or business
Date and detailed reason for cancellation/suspension/denial
18. Has the applicant, any person listed in item 12, or any business listed in item 14 (at the time anyone listed in
item 12 was so connected with that business) been finally determined to have violated any provision of
Article 20 (Cigarette Tax) or Article 20-A (Cigarette Marketing Standards Act), or any rule or regulation
adopted pursuant to Tax Law Articles 20 or 20-A? .....................................................................................................
Yes
No
If Yes, complete below. Attach additional sheets if necessary.
Name of applicant, person, or business
Date of violation
/
/
Statute section, rule or regulation section violated
Detailed description of violation
Disposition (fine, imprisonment, etc.)
Page 4 of 4 CG-80 (11/04)
19. List all current or anticipated cigarette suppliers. Attach additional sheets if necessary.
Name of supplier
Address of supplier
Street
City
State
ZIP Code
Street
City
State
ZIP Code
Street
City
State
ZIP Code
20. If you are applying as a cooperative member, did you purchase from the cooperative in the preceding
3 months at least 25% of all merchandise purchased for resale (excluding cigarettes and petroleum
products)? The calculation of the percentage is based on price paid ........................................................................
Yes
No
21. If you are applying as a cooperative member, do you share in the profits and losses of the cooperative? ...................
Yes
No
22. If you are applying as a large volume outlet operator, did one or more of your retail outlets
through which cigarettes are sold in New York State have gross sales (excluding petroleum
products) of more than $2,000,000 in the preceding calendar year? .........................................................................
Yes
No
Note: This application for registration as a chain store will not be approved until all of the following conditions are met:
— You are registered as a sales tax vendor. Include a copy of the sales tax Certificate of Authority for each outlet. If you are not so
registered, submit Form DTF-17, Application for Registration as a Sales Tax Vendor (see Need help? on Form CG-80-
I
).
— You and all persons listed in item 12 have satisfied all outstanding tax liabilities and have filed all appropriate tax returns.
— You have submitted the required documentation for the type of business under which you are registering as a chain store (see
instructions) .
— You have registered each location and each vending machine. If not, submit Form DTF-716, Application for Registration of Retail
Dealers and Vending Machines for Sales of Cigarettes and Tobacco Products.
— You are licensed as a wholesale dealer if you own, operate, or maintain one or more cigarette vending machines in, at, or upon
premises owned or occupied by another person. If you are not licensed as a wholesaler dealer but should be, submit
Form CG-100-V, Application for License as a Wholesale Cigarette Dealer Who Only Operates Vending Machines .
— The application is signed and dated by an officer, director, shareholder, partner, or the sole proprietor listed in item 12 of this
application.
— A bank check, certified check, money order, or other draft acceptable to the department for the applicable registration fee, made
payable to, Commissioner of Taxation and Finance , is submitted with the application. Mail all documents to:
NYS TAX DEPARTMENT
TTTB FACCTS - REGISTRATION AND BONDING UNIT
BUILDING 8
W A HARRIMAN CAMPUS
ALBANY NY 12227
Warning
The Department of Taxation and Finance has the right to suspend or revoke a registration as a chain store for violation of the provisions of
Tax Law Article 20 (Cigarette Tax Law) or Tax Law Article 20-A (Cigarette Marketing Standards Act).
It is a Class B misdemeanor for a chain store to induce or attempt to induce, or to procure or attempt to procure, the purchase of
cigarettes at a price less than the cost of the agent or wholesaler with respect to sales to chain stores.
It is also a Class B misdemeanor for a chain store to induce or attempt to induce, or to procure or attempt to procure, any rebate or
concession of any kind in connection with the purchase of cigarettes.
Making a false or misleading statement on this application will be viewed by the department as an attempt to procure cigarettes below the
minimum price and will result in the revocation or your registration as a chain store. In addition, the department may forbid you from
subsequently selling cigarettes at retail.
I certify that the information herein provided is true and correct to the best of my knowledge, and that the
Certification —
applicant herein named is qualified under the Cigarette Marketing Standards Act to be a chain store.
Name
Title
(print)
Signature
Date
Page of 4