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Ets Form 007 - Cigarette Wholesalers & Other Tobacco Wholesalers, Cigarette Importer, Cigarette Manufacturer License Application Page 2

NOTICE TO WYOMING LICENSED TOBACCO WHOLESALERS

This is a joint notice from the Wyoming Department of Revenue Excise Tax Division and the Wyoming Attorney

General’s Office Tobacco Settlement Unit.

Wyo. Stat. § 39-18-106(a), states in part:

Every wholesaler who sells or offers to sell cigarettes, cigars, snuff or other

tobacco products in this state must have a license to do so issued by the

department. No license or renewal of a license shall be granted under this

section unless the wholesaler states in writing, under penalty of false

swearing, that he shall comply fully with W.S. 9-4-1201 through 9-4-1209.

Of specific note is W.S. 9-4-1207, which requires every Wyoming licensed tobacco wholesaler to file by the 20

of each

month following the month of sales the form titled: Wyoming Cigarette and Roll-Your-Own Tobacco Wholesaler Report.

This report pertains only to sales of cigarettes and roll-your-own tobacco products. The report might be non-applicable

to your operation, if you deal only in cigars or pipe tobacco, but because you hold a wholesale license that allows you to

deal in cigarette and roll-your-own tobacco product at any time, you must file the report with the Tobacco Settlement

Unit of the Attorney General’s Office, not the Department of Revenue.

Signing this form attests to the Department of Revenue your compliance with W.S. 9-4-1201 through 9-4-1209. Once

signed, return this form to the Department of Revenue on or before the stipulated deadline.

I certify, under penalty of false swearing, that I have read this form, and that I shall fully comply with W.S. 9-4-1201

through 9-4-1209, as it pertains to responsibilities of a Wyoming licensed tobacco wholesaler.

______________________________________________________________________________

Name of Wholesaler License #

______________________________________________________________________________

Address (City, State, Zip)

______________________________________________________________________________

Signature of Authorized Representative Date

______________________________________________________________________________

Printed Name of Authorized Representative and Title

Return this form to:

Department of Revenue

Excise Tax Division

Herschler Bldg., 2

Floor West

Deadline: Must be submitted

Cheyenne, WY 82002

with license application.

Fax - 307-777-3632

For information from the Tobacco Settlement Unit, contact 307-777-5833.

Ets Form 007 - Cigarette Wholesalers & Other Tobacco Wholesalers, Cigarette Importer, Cigarette Manufacturer License Application Page 2