Form 1783 - South Dakota Tobacco Product Manufacturer Complementary Legislation Certification Page 4
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12V.
For each of the above brand families (cigarettes only) provide a copy of the current Center for Disease
Control (CDC) ingredient listing compliance letter(s) and a statement as to which brand’s ingredients were
submitted for each approval letter. Additional information can be obtained at:
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
Telephone: 1-800-311-3435
VI.
Are any cigarette brand families listed above or brands within a brand family listed above manufactured
(fabricated) by an entity other than the applicant listed in Part 1A? Yes _____ No _____
NOTE: If the answer is “Yes,” then identify the brand(s) and the manufacturer by plant street address, contact person,
telephone and facsimile numbers, and e-mail. In addition, explain the relationship between the manufacturer (fabricator)
and applicant. Attach copies of all agreements or contracts between the manufacturer (fabricator) and the applicant.
Attach additional sheets if necessary.
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VII.
Are any RYO brand families listed above or brands within a brand family listed above packaged or
labeled by an entity other than the applicant listed in Part 1A or packaged or labeled by applicant on behalf of
another entity? Yes _____ No _____
NOTE: If the answer is “Yes,” then identify the brand(s) and the other entity by street address, contact person, telephone
and facsimile numbers, and e-mail. In addition, explain the relationship between the other entity and applicant. Attach
copies of all agreements or contracts between the manufacturer and the applicant. Attach additional sheets if necessary.
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