Looking for a Pennsylvania Tax Forms And Templates? Download it for free!

Wholesale Dealer. Any entity, other than a manu-

Part 5: Marking Approval

facturer, that sells cigarettes or tobacco products to

• Before any cigarettes are certified, a manufactur-

retail dealers or other persons for purposes of resale.

er must present its proposed package marking to

Wholesale dealer also includes any entity that owns,

the Department of Revenue for approval.

operates or maintains one or more cigarette or tobac-

• Attach a copy of approval or attach the proposed

co product vending machine in, at or upon premises

marking for approval.

owned or occupied by any other entity.

• Check whether 8-point or larger type is used in

SPECIFIC INSTRUCTIONS

conjunction with, at or around the UPC code.

Part 1: Manufacturer Identification

Part 6: Fee Calculation

Provide your company name, address, phone num-

• Multiply the total number of brand families to be

ber, fax number, Web address, mailing address and

initially certified or re-certified by $1,000.

FEIN. Also provide the name, title and e-mail address

of the person completing the form.

• Multiply the total number brand families to be

supplementally certified by $500.

Part 2: Type of Certification

• Add Lines 3 and 6 for total amount due.

• Initial certification: Due before offering for sale in

Pennsylvania any cigarette after Jan. 1, 2009.

• Remit with the completed certification the total

amount due, made payable to the Pennsylvania

• Re-certification: Due 30 days before prior certifi-

Department of Revenue.

cation expires.

• Supplemental certification: Must be filed if any

Part 7: Certification Information Provided to

brand styles are to be added or removed after ini-

Wholesale Dealers and Agents

tial certification.

• Manufacturers are required to provide a copy of

each certification to all wholesale dealers and

Part 3: Brand Family Certification

agents to which they sell cigarettes.

• Identify each brand family and style of cigarettes

the company intends to sell in Pennsylvania and

• Provide sufficient copies of an illustration of the

seeks to have included in the Fire-Safe Directory.

package marking utilized by the manufacturer for

• Provide the brand name, test date, style (light,

each retail dealer to which the wholesale dealers

ultra light), length and circumference in millime-

or agents sell cigarettes.

ters, flavor (menthol, chocolate), filter/non-filter

and package description (soft pack, box).

Part 8: Designated Contact

• A Brands Addendum page is included in the certi-

Provide the name, title address, e-mail address and

fication packet and is available on the Department

phone and fax numbers of the designated contact.

of Revenue Web site.

The designated contact is the individual who will

receive mailings and other communication from the

Part 4: Test Method

Department.

• Check the box indicating which test method

applies to the brands being certified.

Part 9: Manufacturer Certification

• If an alternative test method is used, attach a

The person completing the certification must be an

copy of the Fire Commissioner’s authorization of

officer, principal, director or other authorized repre-

the test method.

sentative of the manufacturer. The authorized

• Attach most recent test results.

designee’s name and title must be printed legibly.

Instructions For Form Das-115 - Fire-Safe Certification Of Cigarette Manufacturer Application Page 2

Related Articles

Related forms

Related Categories