Form 55b - Tobacco Product Manufacturer'S Certification - 2017 Page 4
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10Part 2: Brand Family Identification
A. Participating Manufacturer
The participating manufacturer identified in Part 1 has the following brand families, each of which the manufacturer
affirms are to be deemed its cigarettes for purposes of calculating its payments under the MSA.
Indicate with an asterisk (*) those brands not being sold in Nebraska as of the date of this Certification (attach
additional sheets if necessary).
Cigarettes or
Cigarettes or
Roll-Your-Own
Roll-Your-Own
Brand Family Name
Brand Family Name
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Note: Notwithstanding the brands listed in Part 2A, the State of Nebraska retains the right to maintain that a brand family
constitutes cigarettes of a different tobacco product manufacturer for purposes of calculating payments under the MSA or
depositing escrow under § 69-2703(2)(a).
B. Nonparticipating Manufacturer
The nonparticipating manufacturer identified in Part 1 has the following brand families, each of which the manufacturer
affirms are to be deemed its cigarettes for purposes of the escrow obligation set forth in Neb. Rev. Stat. § 69-2703(2)(a).
List all brand families sold in the preceding calendar year and at any time in the current calendar year.
Indicate by an asterisk (*) any brand no longer being sold in Nebraska as of the date of this Certification.
.09 oz. of RYO constitutes one unit (attach additional sheets if necessary).
Units Sold
Cigarettes or
Name and Address of All Previous
Brand Family Name
Roll-Your-Own
Manufacturers of Brand Family
in 2016
in 2017
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Cigarettes
RYO
Note: Notwithstanding the brands listed in Part 2B, the State of Nebraska retains the right to maintain that a brand family
constitutes cigarettes of a different tobacco product manufacturer for purposes of calculating payments under the MSA or
depositing escrow under § 69-2703(2)(a).
C. Packaging or Labeling
For each brand family identified in Part 2A or 2B, provide:
1.
A current listing of all UPC codes of cigarettes and RYO products that are manufactured by your company; and
2. A copy of the packaging or labeling.
Note: A copy need not be submitted if a copy of the packaging or labeling has been previously provided to the Office of the
Attorney General and it remains unchanged. If so, check box c.
D. Department of Health and Human Services Ingredient List
For each brand family identified in Part 2A or 2B, provide a copy of the current documentation provided by the
Department of Health and Human Services, Centers for Disease Control and Prevention, and the Office on Smoking
Health showing compliance with the ingredient list submission requirement pursuant to 15 U.S.C. § 1335a.
E. Federal Trade Commission Rotation Plan
For each brand family identified in Part 2A or 2B, provide a copy of the current complete warning rotation plan
submitted to the Federal Trade Commission (“FTC”) pursuant to 15 U.S.C. § 1333 and a copy of the current approval
letter from the FTC for each brand family.
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