Free Form CG-5.1 - New York

New York State Department of Taxation and Finance

Schedule A -- Cigarettes Received with New York Stamps Affixed
Transaction and Transfer Tax Bureau FACCTS/Cigarette Tax

CG-5.1
(5/05)

This schedule must be attached to your monthly Form CG-5, Nonresident Agent Cigarette Tax Report
Name of agent Federal employer identification number (FEIN) Filed with report for the calendar Month: Year: Column B
Enter number of cigarettes (sticks) in the appropriate column(s) Other (indicate pack size)

Column A

Name, address, and FEIN of each supplier

20 packs

25 packs

packs

packs

packs

packs

Totals (enter here and on Form CG-5, Part I, line 3) .................................

Instructions
Who must file this schedule
You must file Form CG-5.1, Schedule A, if you are a nonresident cigarette agent who has received cigarettes with New York stamps affixed from your suppliers during the month covered by this report. A copy of Schedule A must be attached to each Form CG-5, Nonresident Agent Cigarette Tax Report, that you are required to file on or before the 15th day of the month following the month being reported.

Column B - Number of cigarettes received
For each supplier listed in column A, enter in all applicable columns the number of cigarettes (sticks) in packs you received with New York stamps already affixed. Total the number of cigarettes (sticks) in each column and enter the result here and on line 3 of Form CG-5, Nonresident Agent Cigarette Tax Report.

Tax period and taxpayer identification
Enter your legal name and your federal employer identification number (FEIN). Enter the month and year of the period covered by this schedule.

Need help?
Internet access: www.nystax.gov (for information, forms, and publications) Fax-on-demand forms: Business Tax Information Center: From areas outside the U.S. and outside Canada: Hearing and speech impaired (telecommunications device for the deaf (TDD) callers only): 1 800 748-3676 1 800 972-1233 (518) 485-6800 1 800 634-2110

Column A - Suppliers
Enter the name, address, and federal employer identification number (FEIN) of each of your suppliers from whom you received cigarettes with New York stamps already affixed.