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TENNESSEE DEPARTMENT OF REVENUE

INSTRUCTIONS FOR COMPLETING MONTHLY LICENSED DISTRIBUTOR REPORT

Pursuant to Tennessee Code Annotated § 47-31-101, et seq. and § 67-4-2601, et seq., the Department of Revenue is required to

compile information about cigarettes, roll-your-own tobacco, and little cigars for which the licensed agent affixed stamps during the

previous calendar month or otherwise paid the tax due for tobacco products in Tennessee.

THIS FORM MUST BE SUBMITTED MONTHLY IF YOU HAVE THE ABILITY TO TAX STAMP TOBACCO PRODUCTS IN TENNESSEE,

REGARDLESS OF WHETHER YOU STAMPED OR SOLD ANY TOBACCO PRODUCTS DURING THE MONTH REPORTED.

Definitions (Tenn. Code Ann. §67-4-2601 and §67-4-2602)

Generally, the term “Cigarette” means any product that contains nicotine, is intended to be burned or heated under ordinary conditions

of use, and consists of, or contains (i) any roll of tobacco wrapped in paper or in any substance not containing tobacco; or (ii) tobacco,

in any form, that is functional in the product, which because of its appearance, the type of tobacco used in the filler, or its packaging and

labeling, is likely to be offered to or purchased by consumers as a cigarette; or (iii) any roll of tobacco wrapped in any substance

containing tobacco, which, because of its appearance, the type of tobacco used in the filler or its packaging and labeling, is likely to be

offered to, or purchased by, consumers as a cigarette described in clause (i) of this definition.

The term “cigarette” includes “roll-your-own” tobacco (i.e., any tobacco which, because of its appearance, type, packaging, or labeling,

is suitable for use and likely to be offered to or purchased by consumers as tobacco for making cigarettes) and “little cigars” (see Sec.

47-31-102(2)(A) through (B)).

Bidis or beedies must also be reported on this form.

“Tobacco product manufacturer (TPM)” means any person who meets the definition found in Tennessee Code Annotated Sections

47-31-102(9) and 67-4-2601(a). The State interprets the term Atobacco product manufacturer@ to be the entity that fabricates or

assembles the cigarettes.

“Licensed Agent” means any entity that has a license which gives them the ability to purchase and affix tobacco tax stamps.

“Non-Participating Manufacturer” (NPM) means any tobacco product manufacturer who is not a Participating Manufacturer (signatory)

to the Tobacco Master Settlement Agreement, dated Nov. 23, 1998. A tobacco product manufacturer ceases to be a Non-Participating

Manufacturer upon entering into the Master Settlement Agreement.

“Participating Manufacturer” (PM) means any tobacco product manufacturer who is a signatory to the Tobacco Master Settlement

Agreement dated November 23, 1998.

“Tennessee Directory of Compliant Manufacturers” is a listing of both Participating Manufacturers and Non-Participating Manufactur-

ers that have applied and received certification to sell their tobacco products in the State of Tennessee.

Only tobacco products from

TPMs that have been certified and are currently listed on the Directory are legal to sell. Products from TPMs not on the Directory are

contraband and subject to seizure and subsequent penalties.

Instructions for Completing Licensed Distributor Report

**** ALL FIELDS PERTAINING TO THE WHOLESALER MUST BE FILLED OUT ****

These are: 1) Month; 2) Year; 3) Tobacco Wholesale Account Number (this number always begins with “860

”); 4) Business

Name, Address, City, State, Zip Code; 5) Email Address; 6) Signature of Company Officer; 7) Printed Name and Title of Company

Officer signing report; 8) Date report is signed, and 9) Company phone and fax numbers.

To the right of the company name and location section are a number of BOXES. Please note the following instructions carefully:

If this report is amending a previously filed report, check the AMENDED REPORT box. See below in Preparation of Schedule

area for specific requirements regarding Amended Reporting.

2) Samples of packaging are no longer required on a monthly basis UNLESS the packaging has changed from the previous

month. If nothing has changed, the box MUST BE CHECKED, signifying that fact. If it is unchecked, samples of the new

packaging need to be attached with the report. A required packaging submission will now be due annually on August 30th.

3) Below the long, horizontal shaded bar are THREE ADDITIONAL BOXES. Check the appropriate box for the reporting month if

you had: 1) NO Tennessee sales activity, 2) only sold Big Cigars, or 3) all products purchased during reporting period

were either pre-stamped or had the tobacco tax prepaid (i.e., included in your purchase price).

4) You must also fill out the W2W form for all of the following products:

a. Products you stamp and sell to another wholesaler;

b. Products that are prestamped (you did not stamp but received already stamped) and sell to another wholesaler

;

c. Products that you sell unstamped to another wholesaler.

Instructions For Completing Monthly Licensed Distributor Report - Tennessee Department Of Revenue

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