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

Part III: Additional Business Information

Part VI: Disclosure of Prior and Pending Enforcement

Actions and Prior and Pending Determinations

To be completed by NPMs only.

Affecting Applicant or Afﬁ liates

1. Organizational documents

To be completed by NPMs only

If applicant is a:

1. Enforcement actions banning or enjoining sales

• Partnership: Attach a current copy of the partnership

If you answered Yes, attach a copy of each judgment, ruling,

agreement, if any, or the certiﬁ cate required to be ﬁ led

or determination and list on a separate sheet the brand family

by any state, county, or municipality.

banned or enjoined (or sought to be banned or enjoined), the

• Corporation: Attach a current copy of the corporate charter

governmental entity or private plaintiff bringing the action,

or certiﬁ cate of corporate existence or incorporation. This

the case number, and the name and address of the government

copy must be executed by the appropriate state ofﬁ cer for

attorney or ofﬁ cial or private plaintiff bringing the action.

the jurisdiction in which incorporated. Also, attach extracts

of stockholders’ meetings, bylaws, directors’ meetings, or

2. Denial of listing

other documents that list the ofﬁ cers authorized to sign

If you answered Yes, attach a copy of each determination

documents or otherwise act on behalf of the corporation.

and list on a separate sheet the name of the applicant or other

The accuracy of the copy must be certified by an

person or afﬁ liate (or cigarette brand family of the applicant

appropriate ofﬁ cer of the corporation.

or other person or afﬁ liate) denied listing on or removed

• Limited liability company or other business organization:

from (or sought to be denied listing on or to be removed

Attach a current copy of the business documents ﬁ led with

from) a state tobacco directory; the name of the tobacco

the state, county, or municipality where the ﬁ ling is required.

product manufacturer or brand family, or both, denied listing

The copy must show that it was ﬁ led with the appropriate

on or removed from (or sought to be denied listing on or to

government agency. A limited liability company must

be removed from) a state tobacco directory; and the name

provide an accurate copy of its operating agreement.

of the state that denied such listing or removed from such

directory (or sought to deny such listing or to remove from

These documents must include a certiﬁ ed translation into

such directory).

English if the documents are in a language other than English.

3. Afﬁ liates

3. Unfair business practice or competition

Identify any afﬁ liate that also manufactures (fabricates),

If you answered Yes, attach a copy of each judgment and

list on a separate sheet the governmental entity or private

imports, distributes, or sells cigarettes or other tobacco

plaintiff bringing the action, the case number, and the name

products to consumers within Connecticut, whether directly

or through a dealer, distributor, or similar intermediary or

and address of the government attorney or ofﬁ cial or private

intermediaries, by completing this question. For purposes of

plaintiff bringing the action.

Form TPM-2, the term own means ownership of an equity

4. Convictions

interest or the equivalent of 10% or more. List the names of

If you answered Yes, attach a copy of each judgment and list

the brand families and the afﬁ liate in the ﬁ rst two columns.

on a separate sheet the name of the applicant or other person

List the type of business by entering in the fourth column,

or afﬁ liate convicted, the governmental entity (federal, state,

Type of Business, M for manufacturer, I for importer, D for

local, or foreign) that prosecuted the applicant or other person

distributor, and W for wholesaler.

or afﬁ liate, the case number, and the name and address of the

Part IV: Marketing and Distribution Information

government attorney or ofﬁ cial that prosecuted the applicant

To be completed by NPMs only

or other person or afﬁ liate.

5. Denials, suspensions, or revocations of permits

Part V: Manufacturing and Compliance

Information

or licenses

To be completed by NPMs only

If you answered Yes, attach a copy of each letter of denial,

suspension, or revocation and list on a separate sheet

5. Internet, mail order, or other delivery sales to

the name of the applicant or other person or afﬁ liate that

consumers within Connecticut

was denied the permit, license, or other authorization or

If applicant makes or intends to make Internet, mail order, or

had such permit, license, or other authorization revoked,

other delivery sales of cigarettes (including RYO tobacco) to

suspended, or otherwise terminated; the governmental entity

consumers within Connecticut, list and describe any website

(federal, state, local, or foreign) that denied, suspended,

advertising the cigarettes, the physical address from which

revoked, or otherwise terminated the permit, license, or

the cigarettes will be shipped, and the total sales to consumers

other authorization; the case number, if any; and the name

within Connecticut during calendar year 2012.

and address of the government attorney that represented the

governmental entity.

Page 3 of 4

Form TPM-2 Instructions (Rev. 04/13)

Instructions For Form Tpm-2 - Certification For Listing In The Connecticut Tobacco Directory As Of July 1, 2013 Page 3

Related Articles

Related forms

Related Categories