CG-30.1 New York State Department of Taxation and Finance Information Regarding Brands Sold in New York State (2/09) Attachment to Form CG-30 Legal name of manufacturer Date Federal employer identification number (EIN) As required by New York State (NYS) Tax Law sections 480-b and 480-c, every tobacco product manufacturer must list each of its cigarette brands (including roll-your-own (RYO) tobacco) sold for consumption in NYS from January 1 of the prior calendar year until the date of this annual certification. In addition you must list any new brands of cigarettes and RYO tobacco which you intend to sell for consumption for the period covered by this certification prior to the first sale in NYS (see Form CG-30-I, Instructions for Forms CG-30, CG-30.1, and CG-30.2). Following is a list of brands sold for consumption in NYS by the above manufacturer for the period January 1, 20 through , 20 Tobacco product manufacturers who first introduce their products for sale in NYS must list the cigarette and roll-your-own (RYO) tobacco brands they intend to sell before making the first sale of these brands in NYS. Following is a list of brands to be sold for consumption in NYS by the above manufacturer effective , . (month) (day) (year) Complete brand names* RYO New Page Complete brand names* of RYO New * Be sure the complete brand name(s) of the cigarettes or RYO tobacco is listed, including the following (attach additional sheets if necessary): • filtered or unfiltered • descriptive information (such as menthol or slim) • size (such as regular, king, 100’s, etc.) • if brand name is an RYO, mark an X in the RYO box • if brand name is a new brand(s) of cigarettes not included on your prior     certification, mark an X in the New box • other information as necessary to identify the product American LegalNet, Inc. www.FormsWorkflow.com