Form 55b - Tobacco Product Manufacturer'S Certification - 2017 Page 7
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10Part 6: Nonparticipating Manufacturer Liability; Joint and Several Liability
A. Nonparticipating Manufacturer Registered Agent. Please Certify as Follows:
c
The nonparticipating manufacturer identified in Part 1 is domiciled in the State of Nebraska.
c
The nonparticipating manufacturer identified in Part 1 is a nonresident or foreign nonparticipating manufacturer
that has registered to do business in the State of Nebraska as a foreign corporation or business entity.
c
The nonparticipating manufacturer identified in Part 1 has appointed and continues to engage the following
agent located in Nebraska for service of process on whom all process, and any action or proceeding against it
concerning or arising out of the enforcement of Neb. Rev. Stat. §§ 69-2702 through 69-2711 may be served in any
manner authorized by law:
Agent Name
Company
Address
Phone Number
Fax Number
Email Address
Attach a current letter from the registered agent accepting the appointment.
Note: Prior notice must be provided to the Nebraska Attorney General and the Tax Commissioner of any change in the
registered agent set forth in Neb. Rev. Stat. § 69-2707.
B. Consent to be Sued
Provide a properly executed copy of the Consent to be Sued form prepared by the Office of the Nebraska
Attorney General.
C. Acceptance of Joint and Several Liability by Importers
In the case of a nonparticipating manufacturer located outside of the United States, provide a properly executed copy
of the Importer Acceptance of Joint and Several Liability form prepared by the Office of the Attorney General with all
additional documents required to be submitted with said form, including: a copy of the current Importer Permit issued
under 26 U.S.C § 5713; a copy of the Contract, if any, regarding importation of cigarettes; a copy of the Statement by
Importer’s Registered Agent accepting appointment; and three “Proofs of Authority” documents as described therein.
D. Importer’s Registered Agent for Service of Process:
Company Name
Address
City
State
Zip Code
Phone
Fax
Email
Note: A statement from the registered agent accepting appointment in this capacity must be submitted with this
Certification. Pursuant to Nebraska Law, this registered agent must reside in the State of Nebraska.
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