Instructions For Form Tt-19-Npm - Virginia Department Of Taxation (Page 2 of 3) in pdf

Part 5:

Brand Family Identification and Certification.

A. Identify each Brand Family of Cigarettes for which certification is sought . For each

Brand Family, list the number of Units Sold in Virginia during the previous calendar

year. For each Brand Family, if applicable, identify by name and address (1) the

physical fabricator if different from the Tobacco Product Manufacturer and/or (2) any

other manufacturer current or previous manufacturer of such Brand Family.

For each Brand Family, list every Brand Style for which certification is being sought.

For each Brand Family, provide to the Attorney General actual packaging for each

Brand Style. Check the box if the Tobacco Product Manufacturer has previously

submitted such packaging and such packaging has not been changed.

B. For each Brand Family and Brand Style, provide: (1) the Federal Trade Commission's

Health Warning Rotation Plan Approval letter(s); (2) the Centers for Disease Control

and Prevention's Certificate(s) of Compliance and Ingredient Report; and (3) evidence

of trademark ownership.

Part 6:

Stamping Agent Identification.

Identify by name, address and telephone number the Stamping Agent(s) (1) to whom the

Tobacco Product Manufacturer's Cigarettes are sold and/or (2) that affix the excise tax

stamp of the Commonwealth of Virginia to the Tobaccco Product Manufacturer's

Cigarettes, and list the applicable Brand Family(s).

Part 7:

Qualified Escrow Fund.

A. Identify the contact person's name, the financial institution where the certifying entity

has established a Qualified Escrow Fund, address, telephone number, facsimile

number and electronic mail address. Identify the account number of such Qualified

Escrow Fund and any sub-account number for the Commonwealth of Virginia.

B. Identify by date and amount each deposit and withdrawal from the Virginia sub-

account, showing the resulting balance after each transaction. Calculate the total

deposits and withdrawals.

A copy of the current Escrow Agreement and any amendments thereto must be attached

to this Certification. The current Escrow Agreement and any amendments thereto must be

approved by the Attorney General of Virginia before the Tobacco Product Manufacturer

can be certified.

A current account ledger and statement from the Escrow Agent verifying all transaction records

for the Commonwealth of Virginia sub-account must be attached to the Certification.

Instructions For Form Tt-19-Npm - Virginia Department Of Taxation Page 2