Form Dr 0231 - Tobacco Product Manufacturer Certification (Page 2 of 4) in pdf

When is this certification due?

This Certificate of Compliance is to be received after April 16

and before April 30

of the year following the

sales year.

SPECIFIC INSTRUCTIONS.

Part 1:

Manufacturer’s Identification.

Identify the name, address, telephone, fax number and electronic mail address.

Part 2:

Sales Year.

Identify the sales year.

Part 3:

Brand Family Identification.

Identify by brand family and brand name all of the cigarettes that the Tobacco Product Manufacturer

intends to sell in Colorado whether directly or through any distributor, retailer, or similar intermediary,

and seeks to have included in the directory. Only the brands identified will be included in the directory.

A Participating Manufacturer shall include a list of its brand families. The Participating Manufacturer

shall update such list thirty calendar days prior to any addition to or modification of its brand families

by executing and delivering a supplemental certification to the Attorney General and the Department

of Revenue.

A Non-Participating Manufacturer shall include in its certification (i) a list of all of its brand families

and the number of units sold for each brand family that were sold in Colorado during the preceding

calendar year, (ii) a list of all of its brand families that have been sold in Colorado at any time during the

current calendar year, (iii) indicating, by an asterisk, any brand family sold in Colorado during the

preceding calendar year that is no longer being sold in Colorado as of the date of such certification, and

(iv) identifying by name and address any other manufacturer of such brand families in the preceding or

current calendar year. The Non-Participating Manufacturer shall update such list thirty calendar days

prior to any addition to or modification of its brand families by executing and delivering a supplemental

certification to the Attorney General and the Department of Revenue.

Part 4:

Non-Participating Manufacturer Certification.

A. Verify that the Non-Participating Manufacturer is registered to do business in Colorado or has appointed

an agent for service of process and provided notice thereof as required by C.R.S. 39-28-304.

B. Identify (i) the name, address and telephone number of the financial institution where the Non-

Participating Manufacturer has established a Qualified Escrow Fund pursuant to C.R.S. 39-28-202(6);

(ii) the account number of such Qualified Escrow Fund and any sub-account number for Colorado.

C. Identify (i) the amount such Non-Participating Manufacturer placed in such fund for cigarettes sold

in Colorado during the preceding calendar year, the date and amount of each such deposit; and (ii)

the amount and date of any withdrawal or transfer of funds the Non-Participating Manufacturer

made at any time from such fund or from any other Qualified Escrow Fund.

Signature: The person executing the Certification must do so before an authorized notary.

Form Dr 0231 - Tobacco Product Manufacturer Certification Page 2