Form Tt-19-Npm - Tobacco Product Manufacturer Certification For Non-Participating Manufacturers

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FORM TT-19-NPM
COMMONWEALTH OF VIRGINIA
Tobacco Product Manufacturer Certification for Non-Participating Manufacturers
Part 1: Type of Certification (check one)
□
Initial Certification
□
Annual Certification for Sales Year _______ (Due by April 30 each year)
□
Supplemental Certification (Due thirty (30) days prior to any change in Certification)
Part 2: Tobacco Product Manufacturer Identification
Full Legal Name:
Type of Business Entity (check one):
□
Sole Proprietorship
□
General Partnership
□
Limited Partnership
□
Corporation
□
Limited Liability Company
□
Other (specify):
State/Country where Created, Incorporated or Registered:
Include with certification:
• A copy of the current Articles of Incorporation, Certificate of Limited Partnership, Articles
of Organization, or comparable applicable document, including any amendments, must be
attached to the certification.
• A copy of the Manufacturer’s current TTB Tobacco Permit, with any amendments.
Trading As (list all names ever used):
Federal Employers Identification Number:
Federal Tobacco Manufacturer Permit Number:
Physical Address:
Mailing Address:
Page 1 of 9
0000000 Rev 01/12

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