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

Part IX: Declaration, Acknowledgment, and

Qualiﬁ ed escrow fund statute compliance

Signature

If you answered Yes to Question 6, attach a copy of each

To be completed by PMs and NPMs.

claim made by a state and list on a separate sheet the name

and address of the government attorney or ofﬁ cial making

An ofﬁ cer of the applicant with the authority to bind the

the claim, the brand families for which there was a failure to

applicant must sign Form TPM-2 before a proper ofﬁ cial

make adequate or timely escrow deposits, and the amounts

such as a notary public. Proof of the ofﬁ cer’s authority to

of any escrow deposits still owed.

bind the applicant, such as the text of a resolution passed by

the applicant’s board of directors, must be submitted along

If you answered Yes to Question 7, attach a copy of the claim

with a certiﬁ cation by another ofﬁ cer of the applicant, such as

made by a state and list on a separate sheet the name of the

the Secretary of the applicant, that the copy of the resolution

applicant or other person or afﬁ liate that failed to make

is accurate and was in force on the date Form TPM-2 was

adequate or timely escrow deposits, the name and address

signed. These documents must include a certiﬁ ed translation

of the government attorney or ofﬁ cial making the claim, the

into English if they are in a language other than English.

brand families for which there was a failure to make adequate

or timely escrow deposits, and the amounts of any escrow

The ofﬁ cer who signs Form TPM-2 is guilty of a felony

deposits still owed.

punishable by imprisonment not to exceed ﬁ ve years or a ﬁ ne

not to exceed $5,000, or both, if the ofﬁ cer makes an assertion

If you answered Yes to Question 8, attach a copy of the

on Form TPM-2 that he or she knows to be fraudulent or false

agreement or settlement and list on a separate sheet the name

in any material matter.

and address of the government attorney or ofﬁ cial with whom

the agreement or settlement was negotiated and the amounts

Mail the original Form TPM-2 and a complete copy of all

of any escrow deposits still owed.

required forms, documents, and attachments to:

Department of Revenue Services

Part VII: Imported Cigarettes: Documentation and

Tax Division Chief, Audit Division

Veriﬁ cation

Excise/Public Services Subdivision

To be completed by NPMs only

25 Sigourney St Ste 2

Part VIII: NPM Applicant Certiﬁ cation

Hartford CT 06106

Completed by NPMs only

Mail a copy of Form TPM-2 and a complete copy of all

required forms, documents, and attachments to:

1. Agent for service of process

Ofﬁ ce of the Attorney General

An NPM must certify whether it is organized under the laws

Finance Department

of the State of Connecticut, it is a nonresident or foreign

PO Box 120

NPM that has registered with the Secretary of the State to

Hartford CT 06141-0120

do business in Connecticut under Title 33 or Title 34 of

the Connecticut General Statutes as a foreign corporation

or business entity, or if it is not organized under the laws

of the State of Connecticut and is not registered with the

Secretary of the State to do business in Connecticut under

Title 33 or Title 34 of the Connecticut General Statutes as

a foreign corporation or business entity, it has appointed

a resident agent for service of process under Conn. Gen.

Stat. §4-28n on whom all process and any action against it

concerning or arising out of the enforcement of Conn. Gen.

Stat. §§4-28h through 4-28r and implementing regulations,

may be served in any manner authorized by law.

Page 4 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 4

Related Articles

Related forms

Related Categories