Form Cg-5.4/6.4 - Sale Of Cigarettes To Indian Nations Or Tribes Or Reservation Cigarette Sellers - 2011

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Use for periods on or after June 21, 2011
CG-5.4/6.4
New York State Department of Taxation and Finance
Schedule E — Sale of Cigarettes to Indian Nations
(6/11)
or Tribes or Reservation Cigarette Sellers
Transaction Desk Audit Bureau FACCTS/Cigarette Tax
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 each sale of cigarettes to an Indian nation or tribe or reservation cigarette seller.
Enter number of cigarettes
List Indian tax exemption
FEIN/social security
(sticks) in the appropriate
Name of manufacturer
Name and address of purchaser, and
number (include nation or
coupon number(s) or
column(s) per brand
and
name of the reservation where purchaser
tribe exempt organization
prior approval reporting
brand of cigarettes
is located
*
Other
number, if applicable)
confirmation number(s)
20 packs
25 packs
packs
Totals ........................................................................................................................................................................
Please attach additional Schedule E sheets if necessary.
* Indicate pack size.

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