Form Cg-11-Mn - Cigarette Tax Floor Tax Return Page 2

Page 2 of 3 CG-11-MN (6/10)

Schedule A - Consolidated filers

The schedule below must be completed by vendors who are filing one floor tax return for cigarettes that are stored or offered

for sale at more than one location. Report the inventory of stamped packs of cigarettes on hand as of the close of business on

June 30, 2010, at each location. Keep the original inventory report for inspection at each location.

Note: 1 pack of 25 = 1.25 packs of 20

Give totals by packs of 20 cigarettes, not cartons, at each location

Business name, address, and sales tax and cigarette tax identification

Number of packs

numbers of each location where cigarettes are stored or offered

with New York State

with New York State and

for sale

stamp only

New York City joint

stamps

Totals

Column 1 total

(enter here and include on line 7)

Column 2 total

(enter here and include on line 8)

— Attach additional sheets if necessary —

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Parent category: Financial