Form Tt-19-Npm - Tobacco Product Manufacturer Certification For Non-Participating Manufacturers
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6FORM TT-19-NPM
COMMONWEALTH OF VIRGINIA
Tobacco Product Manufacturer Certification for Non-Participating Manufacturers
Part 1: Type of Certification (check one)
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Initial Certification
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Annual Certification for Sales Year _______ (Due by April 30 each year)
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Supplemental Certification (Due thirty (30) days prior to any change in Certification)
Part 2: Tobacco Product Manufacturer Identification
Full Legal Name:
Trading As (list all names ever used):
Federal Employers Identification Number:
Federal Tobacco Manufacturer Permit Number:
Physical Address:
Mailing Address:
Company Phone:
Contact:
Title:
Phone:
Fax:
Email:
Website:
State/Country where Incorporated or Registered:
Name, Title and Dates of Service for all Current and Past Officers, Directors and/or Partners:
Rev. 02.01.05
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Parent category: Legal