Form Tpm-3 - Brand Families Unit Sales Schedule

Form TPM-3

2012

State of Connecticut

Calendar year

Brand Families Unit Sales Schedule

Sales Made During Calendar Year 2012

This form must be submitted with the 2012 Form TPM-1, Certiﬁ cation of Compliance and Afﬁ davit by Nonparticipating Manufacturer.

(Rev. 04/13)

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Complete this form in blue or black ink only.

Company is a (Check one.)

Manufacturer

Importer

Check if this is an amended form.

Company name

Department of Revenue Services (DRS) Cigarette Manufacturer License Number

Company address

Number and street

PO Box

City, town, or post ofﬁ ce

State or province

Country

Telephone number

Facsimile (FAX) number

Email address

(

)

(

)

Part I - Instructions

Column A:

List all brand families sold during calendar year 2012. Indicate by asterisk (*) in the column to the left of Column A any brand family no longer sold in Connecticut as of the date this form is signed.

Column B:

Product type codes



Enter C for any brand family of cigarettes.



Enter RYO for any brand family of roll-your-own tobacco. Each 0.09 ounce of roll-your-own tobacco constitutes one stick.



Enter LC for any brand family of little cigars that are properly treated as cigarettes for the purposes of the federal excise tax on cigarettes (26 U.S.C. §5701(b)).

Column C:

List the total sticks sold in Connecticut during calendar year 2012.

Column D:

If the reporting company is not the manufacturer (the fabricator), provide the name, address, and Federal Employee Identiﬁ cation Number (FEIN) of the manufacturer.

Part I - Total sales made to consumers within Connecticut, whether directly or through a distributor, dealer, or similar intermediary or intermediaries, during calendar year 2012

Column A

Column B

Column C

Column D

Brand Family Name(s)

Product Type Codes

Total Sticks

Manufacturer (Fabricator) Name, Address, and FEIN

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