Free CG-5/6-ATT - New York

New York State Department of Taxation and Finance

Schedule B -- Cigarette Packages Stamped During the Month
Transaction and Transfer Tax Bureau FACCTS/Cigarette Tax
Read instructions for Parts I and II carefully (Form CG-5/6-ATT-I). This form must be attached to your monthly report, either Form CG-5 or CG-6. Name of agent

CG-5/6-ATT
(5/05)

Federal employer identification number (FEIN) Filed with report for the calendar Month: Year:

Part I -- Direct purchases
Section A -- Participating manufacturers
Cigarette packs purchased directly from participating manufacturers to which you affixed New York State tax stamps this month. Column A Column B Manufacturer's FEIN Column C
Number of packs you affixed with New York State tax stamps Packs of 20 cigarettes Packs of 21 - 25 cigarettes

Name and address of manufacturer

1. Total packs listed in Part I, Section A ..............................................................................................

Section B -- Non-participating manufacturers
Cigarette packs purchased directly from non-participating manufacturers to which you affixed New York State tax stamps this month. Column A Column B Manufacturer's FEIN Column C Brand(s) of cigarettes Column D
Number of packs you affixed with New York State tax stamps Packs of 20 cigarettes Packs of 21 - 25 cigarettes

Name and address of manufacturer

2. Total packs listed in Part I, Section B .............................................................................................. 3. Total packs listed on attached additional Part I, Section A sheets .................................................. 4. Total packs listed on attached additional Part I, Section B sheets .................................................. 5. Total packs listed in Part II, line 9 .................................................................................................... 6. Total number of cigarette packs stamped (add lines 1 through 5). These amounts must match the total number of tax stamps required to be affixed to each pack size as shown on Form CG-5, Part III, line 15, or Form CG-6, Part II, line 17. ......................................

CG-5/6-ATT (5/05) (back)

Part II -- Non-direct purchases
Cigarette packs purchased directly from suppliers other than their manufacturers to which you affixed New York State tax stamps this month. Column D Column A Name, address, and FEIN of supplier Column B Name, address, and FEIN of the manufacturer (if known) or first purchaser Column C Brand(s) of cigarettes
Number of packs you affixed with New York State tax stamps (either state only or joint state/city)

Packs of 20 cigarettes

Packs of 21 - 25 cigarettes

7. Total packs listed in Part II .............................................................................................................. 8. Total packs listed on attached additional Part II sheets .................................................................. 9. Total for Part II (add lines 7 and 8). Enter result here and on the front page, Part I, line 5 ................

Attach additional sheets if necessary