Form Cg-11-Mn - Cigarette Tax Floor Tax Return Page 3

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CG-11-MN (6/10) Page 3 of 3
Schedule B - Vending machine operators
In the columns below, list your warehouse as well as each vending machine separately.
Give the business name and address where each machine is located, and the identification or control card number and
inventory of each machine.
Note: 1 pack of 25 = 1.25 packs of 20
1
2
Business name and address where
Identification or control
Number of packs of 20
Number of packs of 20
cigarettes are stored or offered for sale
card number of each
New York State stamped
New York State and
vending machine
cigarettes
New York City joint
(report each vending machine separately)
stamped cigarettes
Totals
Column 1 total
(enter here and include on line 7)
Column 2 total
(enter here and include on line 8)
— Attach additional sheets if necessary —

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