Form 04-510 - Tobacco Product Manufacturer Certificate Of Compliance (Page 4 of 5) in pdf

Tobacco Product Manufacturer Certificate of Compliance - Instructions

General Instructions

Who Must File.

Every tobacco product manufacturer (TPM)

at least $1,000,000,000 (U.S. funds). Escrow arrangements

whose cigarettes are sold in this state or who intends to sell its

mustrequire that the financial institution hold the principal of the

cigarettes in this state shall complete and forward a certificate of

escrow fund for the benefit of the State of Alaska and releasing

compliance certifying, under penalty of perjury, that the TPM is

parties, as defined in the MSA, and prohibit the tobacco product

either a participating manufacturer (PM), as that term is defined in

manufacturer that places money into the escrow fund from using,

sec. II(jj) of the Master Settlement Agreement (MSA), or is a Non-

accessing, or directing the use of the principal of the fund except

Participating Manufacturer (NPM), as that term is defined in sec.

as consistent with the provisions in AS 45.53.

II(cc) of the MSA. The NPM must further certify that it is in full

compliance with Alaska Statute (AS) 45.53. AS 45.53 requires that

Specific Instructions

an NPM must establish a qualified escrow account for the benefit of

the State of Alaska and other releasing parties for each cigarette it

Part I:

Tobacco Product Manufacturer Identification.

You

manufactured that was sold in Alaska. The NPM is responsible to

must provide the complete name, address and telephone number

make escrow payments even if it did not directly sell its cigarettes

of the manufacturer and provide the name of the person

into Alaska.

completing this report. Indicate whether the TPM is a participating

manufacturer or a non-participating manufacturer.

If this is an

Directory. Not later than July 30 of each year, the Commissioner

initial certificate of compliance check the box. An initial certificate

shall develop and make available for public inspection a directory

of compliance must be filed at least thirty days before cigarettes

listing all tobacco product manufacturers that have provided current

are first sold in the state and is a request to have the TPM's brands

and accurate certificates of compliance and all brand families listed

included in the Directory. The escrow payment under Part IV, B

in those certifications. Cigarette brands not listed in the directory

does not need to be calculated on an initial certificate of

may not be sold in Alaska. Cigarette brands sold, offered for sale,

compliance, however, all other information must be completed and

or possessed for sale in this state that are not included in the

an escrow account must be established at a qualified institution

directory are contraband and subject to seizure and forfeiture.

before an NPM and its brands will be listed in the Directory.

Tobacco Product Manufacturer Defined.

A tobacco product

Part II: Sales Year. Identify the year of sales (not the year you

manufacturer means an entity that, on or after June 3, 1999,

prepared this certificate) for which this certificate of compliance is

directly, and not exclusively through an affiliate, manufactures

being completed.

For example, if you are preparing your

cigarettes anywhere that such manufacturer intends to be sold in

certificate in 2007, you are reporting, by brand and brand family,

the United States, including cigarettes intended to be sold in the

the sales for the year 2006.

You must complete a separate

United States through an importer; unless such cigarettes are sold

certificate for each sales year.

in the United States exclusively through an importer that is an

original participating manufacturer as defined in the MSA; is the

Part III: Brand Family Identification. Identify by Brand Family

first purchaser anywhere for resale in the United States of

and Brand name all of the cigarettes that the TPM has sold or

cigarettes manufactured anywhere that the manufacturer does not

intends to sell in Alaska whether directly or through any distributor,

intend to be sold in the United States; or is a successor of any

retailer, or similar intermediary, and seeks to have included in the

entity described above.

Directory.

Only the brands identified may be included in the

Directory.

Cigarette Defined.

A cigarette is any product that contains

nicotine that is intended to be burned or heated under ordinary

A PM shall include only brands that are considered to be its

conditions of use. Cigarette includes any roll of tobacco wrapped

cigarettes for purposes of calculating its payments under the

in paper or in any substance not containing tobacco; tobacco, in

Master Settlement Agreement. The PM shall update such list thirty

any form, that is functional in the product, which, because of its

calendar days prior to any addition to or modification of its Brands

appearance, the type of tobacco used in the filler, or its packaging

or Brand Families by executing and delivering a supplemental

and labeling is likely to be offered to, or purchased by, consumers

certification to the Commissioner.

as a cigarette; or any roll of tobacco wrapped in any substance

containing tobacco which, because of its appearance, the type of

An NPM shall include in its certificate (i) a list of all of its Brands

tobacco used in the filler, or its packaging and labeling, is likely to

and Brand Families and the number of Units Sold for each Brand

be offered to, or purchased by, consumers as a cigarette. 0.09

Family that were sold in Alaska during the preceding calendar

ounces of “roll-your-own” tobacco constitutes one individual

year, (ii) a list of all of its Brand Families that have been sold in

“cigarette.” “Roll-your-own” includes any tobacco that, because of

Alaska at any time during the current calendar year, (iii) indicate,

its appearance, type, packaging, or labeling is suitable for use and

by an asterisk, any Brand or Brand Family sold in Alaska during

likely to be offered to, or purchased by, consumers as tobacco for

the preceding calendar year that is no longer being sold in Alaska

making cigarettes.

as of the date of such certification, and (iv) identify by name and

address any other manufacturer of such Brand or Brand Families

Qualified Escrow Fund. To be a qualified escrow fund, the fund

in the preceding or current calendar year. The NPM shall only

must be an escrow fund governed by an escrow arrangement with

include those Brands and Brand Families that are considered to be

a U.S. federally or state chartered financial institution having no

its cigarettes for purposes of AS 45.53.

affiliation with a tobacco product manufacturer and having assets of

Form 04-510 (Rev 03/10)

Page 4 of 5

Form 04-510 - Tobacco Product Manufacturer Certificate Of Compliance Page 4

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