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Form Cg-5.4/6.4 Schedule E - Sale Of Cigarettes To Dealers/vendors On American Indian Reservations Page 2

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

Instructions

Who must file this schedule

Name and address of dealer/business

You must file Form CG-5.4/6.4, Schedule E, if you are a

Enter the name and address of each dealer or business

New York State cigarette stamping cigarette agent who has

located on a recognized American Indian reservation within

sold unstamped cigarettes to dealers or vendors located on

New York State to whom unstamped cigarettes were sold

recognized American Indian reservations within New York

during the period covered by the report. For each dealer or

State.

business listed, indicate their federal employer identification

number (FEIN), social security number, or nation or tribe

A copy of Schedule E must be attached to each Form CG-6,

exempt organization number, if applicable. In addition, list the

Resident Agent Cigarette Tax Report, or Form CG-5,

manufacturer’s name and brand of cigarettes, as well as the

Nonresident Agent Cigarette Tax Report, that you are

number of cigarettes (sticks) sold to each dealer or business

required to file on or before the 15th day of the month

on a per brand basis for each pack size.

following the month being reported.

Total the number of cigarettes (sticks) in each column and

Tax period and taxpayer identification

enter the result here and on Form CG-5, Part II, line 7, or on

Form CG-6, Part I, line 9.

Enter your legal name and your federal employer

identification number (FEIN).

Enter the month and year of the period covered by this

schedule.

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Hotline for the hearing and speech impaired:

Internet access:

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(for information, forms, and publications)

for the deaf (TDD), contact us at 1 800 634-2110. If

you do not own a TDD, check with independent living

Fax-on-demand forms: Forms are

centers or community action programs to find out

available 24 hours a day,

where machines are available for public use.

7 days a week.

1 800 748-3676

Persons with disabilities: In compliance with the

Telephone assistance is available from 8:00

A.M.

Americans with Disabilities Act, we will ensure that

5:00

(eastern time), Monday through Friday.

P.M.

our lobbies, offices, meeting rooms, and other facilities

are accessible to persons with disabilities. If you have

To order forms and publications:

1 800 462-8100

questions about special accommodations for persons

Business Tax Information Center:

1 800 972-1233

with disabilities, please call 1 800 972-1233.

From areas outside the U.S. and

outside Canada:

(518) 485-6800

Form Cg-5.4/6.4 Schedule E - Sale Of Cigarettes To Dealers/vendors On American Indian Reservations Page 2

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