Free Form CG-6.1 - New York

New York State Department of Taxation and Finance

Schedule A -- Unstamped Cigarettes Manufactured, Purchased, or Otherwise Acquired During the Month
Transaction and Transfer Tax Bureau FACCTS/Cigarette Tax Name of agent Federal employer identification number (FEIN)

CG-6.1
(5/05)

Read instructions below carefully. This schedule must be attached to your monthly Form CG-6, Resident Agent Cigarette Tax Report
Filed with report for the calendar Month: Year: Column C
Enter number of cigarettes (sticks) in the appropriate column(s) Other (indicate pack size) 20 packs 25 packs packs packs packs packs

Column A
Name and address of manufacturer (including self) or seller from whom unstamped cigarettes were purchased or otherwise acquired

Column B
Manufacturer's FEIN

Totals (enter here and on Form CG-6, Part I, line 2) .....

Instructions
Tax period and taxpayer identification
Enter your legal name, your federal employer identification number (FEIN), and the month and year of the period covered by this schedule. Column B - Enter the federal employer identification number (FEIN) for each manufacturer or supplier listed. If the manufacturer or supplier does not have an FEIN, indicate N/A.

Column C - For each manufacturer (including yourself, if Column A - Enter the name and address of each manufacturer applicable) or supplier who sold or supplied you with unstamped or supplier who sold you unstamped cigarettes during the cigarettes, indicate by pack size the number of cigarettes (sticks) month covered by this report. Include your own business if you received or manufactured during the month. manufactured cigarettes for sale. Attach additional sheets if necessary