Form Rev 82 2107-1 - Non-Participating Manufacturer Reporting Instructions

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State of Washington
Non-Participating Manufacturer
Department of Revenue
Special Programs Division
PO Box 47477
Reporting Form and Instructions
Olympia WA 98504-7477
Instructions for Completing Reverse Side
As part of the Master Settlement Agreement between
certain cigarette manufacturers and the state of
Column A:
Washington, the Department of Revenue is required to
compile information about cigarettes and roll-your-own
Enter the number of individual cigarettes sold in
tobacco sold in Washington. Please refer to
Washington in packages bearing the excise tax stamp
Chapter 70.157 RCW and WAC 458-20-264.
of this state. List only cigarettes contained in packages
to which you affixed the excise tax stamp of
Complete this form and submit it monthly if:
Washington. Do not list cigarettes that were purchased
you are a cigarette wholesaler;
with the tax stamp already affixed.
you are a tobacco products distributor; or
Column B:
you sell at retail tobacco products purchased from
Enter number of ounces of roll-your-own tobacco sold in
a person who is not required to file this report in
Washington.
Washington (please see WAC 458-20-264(3)).
Column C:
Definitions
Enter the full brand name of the product sold (do not
"Cigarette" means any product that contains nicotine, is
abbreviate). Do not break down into sub-categories,
intended to be burned or heated under ordinary conditions
such as regular, menthol, light, etc. For example, for a
of use, and consists of or contains (i) any roll of tobacco
cigarette named “Alpha Bravo Gold Menthol Lights”,
wrapped in paper or in any substance not containing
report only “Alpha Bravo Gold”. Do not report as “A B
tobacco; or (ii) tobacco, in any form, that is functional in
Gold” or “A B Gold Menthol Lights”.
the product, which, because of its appearance, the type of
Column D:
tobacco used in the filler, or its packaging and labeling, is
likely to be offered to, or purchased by, consumers as a
Enter the name and address of the non-participating
cigarette; or (iii) any roll of tobacco wrapped in any
manufacturer.
substance containing tobacco, which, because of its
appearance, the type of tobacco used in the filler or its
Column E:
packaging and labeling, is likely to be offered to, or
Enter the name and address of the person from whom
purchased by, consumers as a cigarette described in
each cigarette was purchased.
clause (i) of this definition.
Column F:
The term "cigarette" includes "roll-your-own" tobacco (i.e.,
any tobacco, which, because of its appearance, type,
Enter the name and address of the importer of the
packaging, or labeling, is suitable for use and likely to be
cigarette (if known).
offered to, or purchased by, consumers as tobacco for
making cigarettes). For purposes of this definition of
"cigarette," 0.09 ounces of "roll-your-own" tobacco
Preparation of Schedule
constitutes one individual "cigarette."
If more space is required you may copy this form.
"Tobacco products distributor" means any person who
meets the definitions found in RCW 82.26.010(3).
Return the completed form 25 days after the close
of the reporting month.
"Cigarette wholesaler" means any person who is licensed
pursuant to Chapter 82.24 RCW.
Retain a copy for your files.
"Non-participating manufacturer" means any manufacturer
Please complete this schedule in full and mail to:
of cigarettes or "roll-your-own" tobacco who is not a
signatory to the Master Settlement Agreement. A
Washington State Department of Revenue
manufacturer ceases to be a non-participating
Special Programs Division
manufacturer upon entering into the Master Settlement
PO Box 47477
Agreement. A list of Participating Manufacturers is
Olympia WA 98504-7477
available at the National Association of Attorneys Generals
(NAAG) Web Site,
To inquire about the availability of this document in an alternate format for the visually impaired, please call (360) 753-3217.
Teletype (TTY) users please call (800) 451-7985. You may also access tax information on our Internet home page at
The forms location on the website is
REV 82 2107-1 (3-26-01)

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