Free Form CG-6.3 - New York

New York State Department of Taxation and Finance

Schedule D -- Sales, Transfers, and Returns of Unstamped Cigarettes Within New York State
Name of agent Transaction and Transfer Tax Bureau FACCTS/Cigarette Tax Federal employer identification number (FEIN)

CG-6.3
(5/05) Filed with report for the calendar Month: Year:

Part I - Sales and transfers -- include all sales and transfers of unstamped cigarettes (sticks) to persons located within
New York State

Name, address, and FEIN of each person to whom unstamped cigarettes were sold or transferred

Enter number of cigarettes (sticks) in the appropriate column(s) Other (indicate pack size) 20 packs 25 packs packs packs packs packs

Totals (enter here and on Part III, line 1, below) ............................

Part II - Returns -- include all unstamped cigarettes that were returned to a manufacturer located within New York State Name, address, and FEIN of each manufacturer to whom unstamped cigarettes were returned
Enter number of cigarettes (sticks) in the appropriate column(s) Other (indicate pack size) 20 packs 25 packs packs packs packs packs

Totals (enter here and on Part III, line 2, below) ............................

Enter number of cigarettes (sticks) in the appropriate column(s) Other (indicate pack size)

Part III - Total sales, transfers, and returns 1 Total sales and transfers from Part I .................................... 2 Total returns from Part II ...................................................... 3 Totals (add lines 1 and 2; enter here and on Form CG-6, Part I, line 8) ......

20 packs

25 packs

packs

packs

packs

packs

Attach a copy of this schedule to each Form CG-6.

CG-6.3 (5/05) (back)

Instructions
Who must file this schedule
You must file Form CG-6.3, Schedule D, if you are a resident cigarette agent (located within New York State) who has: · sold unstamped cigarettes to customers located within New York State; or · returned unstamped cigarettes to a manufacturer or others located within the state. Note: Cigarette packages stamped with another state's stamps are considered unstamped for New York State tax purposes. A copy of Schedule D must be attached to each Form CG-6, Resident Agent Cigarette Tax Report, that you are required to file on or before the 15th day of the month following the month being reported.

Part III -- Total sales, transfers, and returns
Line 1 -- Enter the total number of cigarettes (sticks) from Part I in the appropriate columns. Line 2 -- Enter the total number of cigarettes (sticks) from Part II in the appropriate columns. Line 3 -- Add the amounts in each column. Enter the total here and on Form CG-6, Part I, line 8.

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

Part I -- Sales and transfers
Enter the name, address, and federal employer identification number (FEIN) of each customer located within New York State, including New York State governmental entities, to whom unstamped cigarettes were sold during the period covered by the report. For each customer listed, indicate in the appropriate column the number of cigarettes (sticks) sold or transferred. Include sales to other New York State cigarette stamping agents for resale outside the state. Do not include sales to dealers/vendors located on American Indian reservations. These sales must be reported separately on Form CG-5.4/6.4, Schedule E. Do not include sales to U.S. agencies located within New York State on this schedule. These sales should be reported on line 6 of Form CG-6. Total the number of cigarettes (sticks) in each column and enter the result here and in Part III on line 1.

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.

Part II -- Returns
Enter the name, address, and federal employer identification number (FEIN) of each cigarette manufacturer located within New York State to whom unstamped cigarettes were returned during the period covered by the report. For each manufacturer listed, indicate in the appropriate column the number of cigarettes (sticks) returned. Total the number of cigarettes (sticks) in each column and enter the result here and in Part III on line 2.