Form Tob: Sch D - Schedule D - Manufacturers Not Participating In The Tobacco Master Settlement Agreement

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TOB: SCH D

LABAMA

EPARTMENT OF

EVENUE

2/10

, U

& B

• T

ALES

USINESS

IVISION

OBACCO

ECTION

Reset

P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627

Schedule D

Manufacturers Not Participating in the Tobacco Master Settlement Agreement

For the Month of _______________________, __________

(MONTH)

(YEAR)

COMPANY NAME

FEIN OR SSN

ADDRESS

COMPANY E-MAIL ADDRESS

PERMIT / REGISTRATION NUMBER

CITY

STATE

ZIP

CONTACT PERSON

TELEPHONE NUMBER

(

)

–

Pursuant to Code of Alabama 1975, Title 6, Chapter 12 and Revenue Rule 810-7-1-.11, this schedule must be completed to identify manufacturers of cigarettes and roll-your-own tobacco who are not participating in the Tobacco Master Settlement Agreement

and to ascertain taxable units sold in Alabama manufactured by said manufacturers. This schedule is due by the twentieth (20th) of each calendar month for the preceding calendar month’s activity. If you are a cigarette wholesaler or tobacco products distributor

and you did not receive/distribute taxed cigarettes and/or roll-your-own tobacco from a nonparticipating manufacturer, the schedule must be filed and “No Activity” shown on the face of the form. Failure to file the return timely will result in penalties (Code of

Alabama 1975, § 40-2A-11).

SEE INSTRUCTIONS ON REVERSE SIDE • USE ADDITIONAL FORMS IF NEEDED

Number of

Conversion of

Nonparticipating Manufacturer’s Full

Brand Code

Brand Name

Individual Cigarettes

Ounces of

Roll-Your-Own Ounces to

Total Units Sold

Name and Address