Free CG-5.4/6.4 - New York

New York State Department of Taxation and Finance

Schedule E -- Sale of Cigarettes to Dealers/Vendors on American Indian Reservations
Transaction and Transfer Tax Bureau FACCTS/Cigarette Tax

CG-5.4/6.4
(4/06)

This schedule must be attached to your Form CG-5, Nonresident Agent Cigarette Tax Report, or Form CG-6, Resident Agent Cigarette Tax Report
Name Federal employer identification number (FEIN) Filed with report for the calendar Month: Year:

List below all sales of cigarettes to dealers/vendors on American Indian Reservations located within New York State
Federal employer identification number/social security number (include nation or tribe exempt organization number, if applicable)

Name and address of dealer/business

Name of manufacturer and brand of cigarettes

Enter number of cigarettes (sticks) in the appropriate column(s) per brand Other * 20 packs 25 packs packs

Totals (enter these amounts on Form CG-5, Part II, line 7, or on Form CG-6, Part I, line 9) .......................................
*Indicate pack size.

PleaseattachadditionalSchedule Esheetsifnecessary.

CG-5.4/6.4 (4/06) (back)

Instructions

Who must file this schedule
You must file Form CG-5.4/6.4, Schedule E, if you are a New York State cigarette stamping cigarette agent who has sold unstamped cigarettes to dealers or vendors located on recognized American Indian reservations within New York State. A copy of Schedule E must be attached to each Form CG-6, Resident Agent Cigarette Tax Report, or 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.

Name and address of dealer/business
Enter the name and address of each dealer or business located on a recognized American Indian reservation within New York State to whom unstamped cigarettes were sold during the period covered by the report. For each dealer or business listed, indicate their federal employer identification number (FEIN), social security number, or nation or tribe exempt organization number, if applicable. In addition, list the manufacturer's name and brand of cigarettes, as well as the number of cigarettes (sticks) sold to each dealer or business on a per brand basis for each pack size. Total the number of cigarettes (sticks) in each column and enter the result here and on Form CG-5, Part II, line 7, or on Form CG-6, Part I, line 9.

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: Forms are available 24 hours a day, 7 days a week. 1 800 748-3676 Telephone assistance is available from 8:00 A.M. to 5:00 P.M. (eastern time), Monday through Friday. To order forms and publications: Business Tax Information Center: From areas outside the U.S. and outside Canada: 1 800 462-8100 1 800 972-1233 (518) 485-6800 Hotline for the hearing and speech impaired: If you have access to a telecommunications device for the deaf (TDD), contact us at 1 800 634-2110. If you do not own a TDD, check with independent living centers or community action programs to find out where machines are available for public use. Persons with disabilities: In compliance with the Americans with Disabilities Act, we will ensure that our lobbies, offices, meeting rooms, and other facilities are accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, please call 1 800 972-1233.