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TENNESSEE DEPARTMENT OF REVENUE

INSTRUCTIONS FOR COMPLETING MONTHLY LICENSED DISTRIBUTOR REPORT

Pursuant to Tennessee Code Annotated '' 47-31-101, et seq. and 67-4-2601, et seq., the Department of Revenue is required to compile information

about cigarettes, roll-your-own tobacco, and little cigars for which the licensed agent affixed stamps during the previous calendar month or otherwise

paid the tax due for tobacco products in Tennessee.

THIS FORM MUST BE SUBMITTED MONTHLY IF YOU HAVE THE ABILITY TO TAX STAMP TOBACCO PRODUCTS IN TENNESSEE,

REGARDLESS OF WHETHER YOU STAMPED OR SOLD ANY TOBACCO PRODUCTS DURING THE MONTH REPORTED.

Definitions (Tenn. Code Ann. ' 67-4-2601 and 67-4-2602)

Generally, the term “Cigarette” means any product that contains nicotine, is intended to be burned or heated under ordinary conditions of use, and

consists of, or contains (i) any roll of tobacco wrapped in paper or in any substance not containing tobacco; or (ii) tobacco, in any form, that is functional

in the product, which because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be offered to or

purchased by consumers as a cigarette; or (iii) any roll of tobacco wrapped in any substance containing tobacco, which, because of its appearance, the

type of tobacco used in the filler or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette described in clause (i)

of this definition.

The term “cigarette” includes “roll-your-own” tobacco (i.e., any tobacco which, because of its appearance, type, packaging, or labeling, is suitable for use

and likely to be offered to or purchased by consumers as tobacco for making cigarettes) and “little cigars” (see Sec. 47-31-102(2)(A) through (B)).

Bidis or beedies must also be reported on this form.

“Tobacco product manufacturer (TPM)” means any person who meets the definition found in Tennessee Code Annotated Sections 47-31-102(9) and

67-4-2601(a). The State interprets the term Atobacco product manufacturer@ to be the entity that fabricates or assembles the cigarettes.

“Licensed Agent” means any entity that has a license which gives them the ability to purchase and affix tobacco tax stamps.

“Non-Participating Manufacturer” (NPM) means any tobacco product manufacturer who is not a Participating Manufacturer (signatory) to the Tobacco

Master Settlement Agreement, dated Nov. 23, 1998. A tobacco product manufacturer ceases to be a Non-Participating Manufacturer upon entering into

the Master Settlement Agreement.

“Participating Manufacturer” (PM) means any tobacco product manufacturer who is a signatory to the Tobacco Master Settlement Agreement dated

November 23, 1998.

“Tennessee Directory of Compliant Manufacturers” is a listing of both Participating Manufacturers and Non-Participating Manufacturers that have

applied and received certification to sell their tobacco products in the State of Tennessee. Only tobacco products from TPMs that have been certified

and are currently listed on the Directory are legal to sell. Products from TPMs not on the Directory are contraband and subject to seizure and

subsequent penalties.

Instructions for Completing Licensed Distributor Report

**** ALL FIELDS PERTAINING TO THE WHOLESALER MUST BE FILLED OUT. ****

These are: 1) Month; 2) Year; 3) Tobacco Wholesale Account Number (this number always begins with “860_____”); 4) Business Name,

Address, City, State, Zip Code; 5) Email Address; 6) Signature of Company Officer; 7) Printed Name and Title of Company Officer signing

report; 8) Date report is signed, and 9) Company phone and fax numbers.

To the right of the company name and location section are a number of BOXES. Please note the following instructions carefully:

If this report is amending a previously filed report, check the AMENDED REPORT box. See below in Preparation of Schedule area for specific

requirements regarding Amended Reporting.

Samples of packaging are no longer required on a monthly basis UNLESS the packaging has changed from the previous month. If nothing has

changed, the box MUST BE CHECKED, signifying that fact. If it is unchecked, samples of the new packaging need to be attached with the

report. A required packaging submission will now be due annually on August 30th

Below the long, horizontal shaded bar are THREE ADDITIONAL BOXES. Check the appropriate box for the reporting month if you had: 1)

NO Tennessee sales activity, 2) only sold Big Cigars, or 3) all products purchased during reporting period were either pre-stamped or

had the tobacco tax prepaid (i.e., included in your purchase price).

You must also fill out the W2W form for all of the following products:

a. Products you stamp and sell to another wholesaler;

b. Products that are prestamped (you did not stamp but received already stamped) and sell to another wholesaler;

TENNESSEE DEPARTMENT OF REVENUE

Instructions For Completing Licensed Distributor Report - Tennessee Department Of Revenue

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