Form R-5604-B(C) - Schedule Of Credits Tobacco Tax Page 2

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R-5604-B(C)i (11/13)
General Information
This schedule is to be completed for all credits of all tobacco products, including cigarettes and Roll-Your-Own (RYO), that occurred in
the calendar month being reported. The product is to be identified as to whether it was manufactured by a participating (PM) or non-
participating (NPM) manufacturer as recognized by the Master Settlement Agreement (MSA). All necessary documentation establishing
credits (example: affidavit from manufacturer, invoices, correspondence, etc.) must be attached. A copy of this completed schedule and
all supporting documentation for credits on cigarettes and roll-your-own product must be submitted to the Department of Justice, P.O. Box
94005, Baton Rouge, LA 70804-9005.
Cigarettes: report the stick count of cigarettes for which credits are being taken on the respective lines on the return. Please indi-
cate if the cigarettes for which a credit is being claimed were manufactured by a PM or an NPM.
Cigars: enter the total of the manufacturer’s list price for each cigar category included in the calculation of the credit being claimed
on Line 24.
Smoking Tobacco: enter the total of the manufacturer’s list price included in the calculation of the credit being claimed on Line 24.
Please indicate if the RYO product for which credit is being claimed was manufactured by a PM or an NPM.
Other Tobacco Products: enter the total of the manufacturer’s list price of all other tobacco products included in the calculation
of the credit claimed on Line 24.

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