Form Dr 0237 - Certificate Of Compliance By Non-Participating Manufacturer Regarding Escrow Payment
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3DR 0237 (03/07/13)
COLORADO DEPARTMENT OF REVENUE
Excise Tax Accounting Section
1375 Sherman Street., Rm 237
Denver, CO 80261
State of Colorado
Certificate of Compliance by Non-Participating
Manufacturer Regarding Escrow Payment
When is this certificate of compliance due?
General Information
This certificate of compliance is to be filed on or before April
What is the definition of a tobacco product
30th of the year following the sales year. The sales year is a
manufacturer?
calendar year from January 1 through December 31.
•
Any entity that manufactures cigarettes, including roll-
When must I make my escrow payment?
your-own, anywhere that such manufacturer intends to
You must deposit all escrow payments into your qualified
be sold in the United States, including cigarettes that
escrow fund on or before April 15th of the year following the
are intended to be sold in the United States through
sales year. After you have made your deposit, forward a copy
an importer;
of your receipt or other proof of deposit from your financial
•
The first purchaser anywhere for resale in the United
institution to the Office of the Attorney General of the State of
States of cigarettes manufactured anywhere that the
Colorado, along with this signed and notarized certificate of
manufacturer does not intend to be sold in the United
compliance. In addition, after you have made your initial deposit
States; or
into the qualified escrow fund, forward a copy of the escrow
agreement as executed. Finally, forward any amendments to
•
A successor of any entity described above.
the escrow agreement.
Who is required to file this certificate of compliance?
Specific Instructions:
• Any tobacco product manufacturer that:
Part 1: Manufacturer’s Identification.
(1) sells cigarettes within the state of Colorado (whether
Write your name, address, telephone and fax number.
directly or through any distributor, retailer, or similar
intermediary) and
Part 2: Sales Year.
Write the sales year.
(2) has not become a participating manufacturer in the
tobacco Master Settlement Agreement executed on
Part 3: Units Sold.
11/23/98 (the MSA).
Write the number of individual cigarettes and the amount of
“roll-your-own” tobacco (.09 ounces constitutes one cigarette)
If you satisfy these requirements, you must file this
manufactured by you and sold during the sales year in Colorado.
certificate of compliance to report the units of cigarettes
Also include the brand names for which you are remitting an
manufactured by you and sold in the state of Colorado and
escrow payment. Provide sales or invoice documentation to
pay the amount calculated into your qualified escrow fund.
support “units sold” figures. If you consider the information you
What is a non-participating manufacturer?
are attaching to be a trade secret, or confidential commercial
A non-participating manufacturer is any tobacco product
or financial data, you should mark the document(s) as such
manufacturer who has not signed onto the MSA. All non-
before you send it to this office.
participating manufacturers are required to file this Certificate
Part 4: Escrow Rates and Payments.
of Compliance.
Multiply the units sold by the appropriate rate for the sales year
What is a qualified escrow fund?
and write the result as your subtotal. Add the subtotal and the
A non-participating manufacturer that is required to file this
inflation adjustment amount to arrive at the total deposit to be paid
certificate of compliance must establish a qualified escrow
into your qualified escrow account for the applicable sales year.
fund. This means an escrow arrangement with a U.S. federal
Part 5: Financial Institution.
or U.S. state-chartered financial institution having no affiliation
Write the name and address of the financial institution holding
with any tobacco product manufacturer and having assets of
your escrow account. Include your escrow account number.
at least USD $1,000,000,000.00 where such arrangement
(1) requires that the financial institution hold the escrowed
Part 6: Escrow Deposit/Withdrawal History for Colorado
funds’ principal for the benefit of the State of Colorado (and
Write in the date, deposit/withdrawal amount and balance
possibly other “Releasing Parties” as defined in the MSA) and
for each transaction. Also write the total cumulative amount
(2) prohibits the non-participating manufacturer from using,
currently in your escrow account for the benefit of the State
accessing, or directing the use of the funds’ principal except
of Colorado.
as consistent with Colorado’s Tobacco Escrow Funds Law (§
Part 7: Signature.
39-28-203, C.R.S. (2001)).
An authorized notary public must also sign and date this
certificate of compliance.
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