Form Rev 82 2107-2 - Non-Participating Manufacturer Reporting Form
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2Washington State
Department of Revenue
Non-Participating Manufacturer
Special Programs Division
PO Box 47477
Reporting Form and Instructions
Olympia, Washington 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 you are a
Washington. Include complimentary cigarettes that
cigarette wholesaler or if you are a tobacco products
are given away unstamped, if you are liable for the
distributor.
payment of the tax on those cigarettes. Do not list
This reporting form is not to be used for reporting sales
cigarettes that were purchased with the tax stamp
of cigarettes to Indian Tribes with a Cigarette Tax
already affixed
Contract. To report those sales, please use form 82-
Column B:
2109.
Enter number of ounces of roll-your-own tobacco sold
in Washington. List only roll-your-own tobacco where
Definitions
you were liable for Washington’s tobacco products
tax.
"Cigarette" means any product that contains nicotine, is
intended to be burned or heated under ordinary
Column C:
conditions of use, and consists of or contains (i) any roll
Enter the full brand name of the product sold (do not
of tobacco wrapped in paper or in any substance not
abbreviate). Do not break down into sub-categories,
containing tobacco; or (ii) tobacco, in any form, that is
such as regular, menthol, light, etc. For example, for
functional in the product, which, because of its
a cigarette named “Alpha Bravo Gold Menthol Lights”,
appearance, the type of tobacco used in the filler, or its
report only “Alpha Bravo Gold”. Do not report as “A B
packaging and labeling, is likely to be offered to, or
Gold” or “A B Gold Menthol Lights”.
purchased by, consumers as a cigarette; or (iii) any roll of
tobacco wrapped in any substance containing tobacco,
Column D:
which, because of its appearance, the type of tobacco
Enter the name and address of the non-participating
used in the filler or its packaging and labeling, is likely to
manufacturer.
be offered to, or purchased by, consumers as a cigarette
described in clause (i) of this definition.
Column E:
The term "cigarette" includes "roll-your-own" tobacco
Enter the name and address of the person from whom
(i.e., any tobacco, which, because of its appearance,
each cigarette was purchased.
type, packaging, or labeling, is suitable for use and likely
Column F:
to be offered to, or purchased by, consumers as tobacco
for making cigarettes). For purposes of this definition of
Enter the name and address of the importer of the
"cigarette," 0.09 ounces of "roll-your-own" tobacco
cigarette (if known).
constitutes one individual "cigarette."
"Tobacco products distributor" means any person who
Preparation of Schedule
meets the definitions found in RCW 82.26.010(3).
If more space is required you may copy this form.
"Cigarette wholesaler" means any person who is licensed
pursuant to Chapter 82.24 RCW.
Return the completed form 25 days after the close
of the reporting month.
"Non-participating manufacturer" means any
Retain a copy for your files.
manufacturer of cigarettes or "roll-your-own" tobacco
who is not a signatory to the Master Settlement
Please complete this schedule in full and mail to:
Agreement. A manufacturer ceases to be a non-
Washington State Department of Revenue
participating manufacturer upon entering into the Master
Special Programs Division
Settlement Agreement. A list of Participating
PO Box 47477
Manufacturers is available at the National Association of
Olympia WA 98504-7477
Attorneys Generals (NAAG) Web Site,
For tax assistance or to request this document in an alternate format, visit or call 1-800-647-7706.
Teletype (TTY) users may call (360) 705-6718.
REV 82 2107-1 (06/20/05)
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