Form Dr 0231 - Tobacco Product Manufacturer Certification (Page 8 of 10) in pdf

Form Dr 0231 - Tobacco Product Manufacturer Certification Page 8

3. Provide a copy of the current Center For Disease Control (CDC) ingredient-listing (cigarettes only) compliance

letter(s) pertaining to the above brands of cigarettes and a statement from the manufacturer as to which brand’s

ingredients were submitted for each approval letter. Additional information can be obtained at:

Center For Disease Control and Prevention

1600 Clifton Road

Atlanta, GA 30333

Telephone: 1-800-CDC-INFO (232-4636)

4. The Prevent All Cigarette Tracking (“PACT”) Act, 15 U.S.C. . § § 375, et seq. requires all persons who sell, transfer,

or ship cigarettes or smokeless tobacco in interstate commerce for profit to: (1) register with the Attorney General of the

United States and the Colorado Department of Revenue (enclose a copy of the registration with this application); and

(2) file monthly reports with the Colorado Department of Revenue, no later than the 10th of each month, identifying the

brands, quantities, and recipients of cigarette and smokeless tobacco shipments into Colorado. These provisions apply

to all tobacco product manufactures.

Note: All packing samples, FTC health warning rotations and CDC compliance letters should be mailed to

the Office of the Attorney General only.

G. Trademark Holder(s)

Trademark Holder/Contact

Trademark Registration

Brand

Physical Address

Phone

Person

Number

H. Affiliates

Type of Business (manufacturer,

Brand Family

Affiliate Name

Affiliate Address

importer, distributor, wholesaler)

I. Distributors/Stamping Agents

Type of Business (manufacturer,

Brand Family

Distributor Name

Distributor Address

importer, distributor, wholesaler)

Note: The state of Colorado will not process incomplete or illegible certifications.

Attach additional sheets as necessary to provide a complete response.

Form Dr 0231 - Tobacco Product Manufacturer Certification Page 8