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INSTRUCTIONS FOR COMPLETING MONTHLY LICENSED DISTRIBUTOR REPORT

(continued)

c. Products that you sell unstamped to another wholesaler.

See specific W2W Form Instructions below.

Column 1: Enter the number of individual cigarettes (“sticks”) or ounces of roll-your-own tobacco or little cigars or bidis (also referred to as

“beedies”) on which you affixed the Tennessee tax stamp or otherwise paid the Tennessee tax due during the reporting period. List only items

contained in packages to which you affixed the excise tax stamp of Tennessee, or to which you have paid the Tennessee tax due (in the case of

RYO). Do not list items that were purchased with the tax stamp already affixed or to which the tax was already paid, as in the case of

RYO. IF QUANTITY ENTERED IS A RETURN, please indicate by putting a negative sign in front of the number of sticks or ounces being

returned.

Column 2: Enter the full brand family of the product listed in Column 1 (do not abbreviate). Do not break down or split into sub-categories, such as

regular, menthol, light, etc. For example, for a cigarette named “Alpha Menthol Lights”, report only “Alpha”. Do not report as “Alpha M Lights” or

“Alpha M L”. Enter only one (1) brand per line.

Column 3: Enter the name and address of the tobacco product manufacturer of the brand family. BOTH Non-participating manufacturers (NPMs) and

Participating Manufacturer (PM) sales are now required to be reported. If cigarettes within the brand family were manufactured by more than one entity,

list each separately. If unsure about the status of a tobacco product, check the Directory of Compliant Manufacturers (website address below).

Column 4: Indicate the type of product being listed, whether the product is a cigarette (C ), roll your own tobacco (RYO) or little cigars (LC).

Column 5: Enter the name and address of the entity from whom each brand family was purchased. If there is more than one, list each separately.

Column 6: Enter the name and address of the importer of the brand family IF THE PRODUCT BEING REPORTED WAS MANUFACTURED BY AN

OFF-SHORE, FOREIGN MANUFACTURER. If there is more than one, list each separately.

W2W Instructions

Transfer the same Wholesaler information from the LDR to the W2W form, completing every field. Do NOT leave anything blank. 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;

c. Products that you sell unstamped to another wholesaler.

Column 1: Enter the shipment date for the product sold to another wholesaler.

Column 2: Enter, using the abbreviations on the form, how this product was transferred.

Column 3: Enter the sales invoice number which lists/itemizes the products being sold/transferred to another wholesaler.

Column 4: Enter each brand family sold in the same manner as described under Column 2 of the LDR instructions.

Column 5: Indicate the type of product being reported, in the same manner as described under Column 4 of the LDR instructions.

Column 6: Indicate whether brand is stamped or unstamped product.

Column 7: Enter name and complete address of wholesaler product is being shipped to/purchased by.

Column 8: Enter number of units (“sticks”) or ounces sold to the purchasing wholesaler/distributor.

PLEASE BE SURE TO SIGN AND DATE THIS FORM!!!

Preparation of Schedule

Χ The State will not process incomplete, unsigned, or illegible reports not submitted on the official form. You must use a current official form.

Reports will be returned for correction and reprocessing if not completed correctly.

Χ Please type or legibly print in BLUE permanent ink. NO PENCIL ENTRIES ARE ALLOWED.

Χ Please number the pages accordingly, noting the total number of pages being submitted.

Χ IF THIS IS AN AMENDED REPORT, please attach all documentation to support the new numbers submitted, including invoices and a

detailed explanation of why the report is being amended. Be sure to indicate the month and year of the report being amended/modified.

Χ IF THE PACKAGING HAS CHANGED SINCE THE PRIOR REPORTING PERIOD, eligible copies (or samples) of the NEW packaging that applies

to each individual brand sold must be attached to this report.

Χ Return the completed form for the reporting period within 20 days of the end of the reporting month. The report should be signed and dated by an

individual authorized to speak for your business.

Χ Please retain a copy of this report, as submitted, for your files. Per Tenn. Code Ann. ' 67-4-2604 (as recently amended), “The licensed agent

shall maintain, and make available to the commissioner, all invoices and documentation of sales of all non-participating manufacturer of cigarettes

and any other information relied upon in reporting to the commissioner for a period of seven (7) years.”

Χ Please always complete this form in full, mailing the original to:

Tennessee Department of Revenue

Andrew Jackson State Office Building

P.O. Box 190590

Nashville, TN 37219

Department of Revenue Website Link for Tennessee Directory of Compliant Manufacturers:

Instructions For Completing Licensed Distributor Report - Tennessee Department Of Revenue Page 2

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