Form Tt-19-Npm - Tobacco Product Manufacturer Certification For Non-Participating Manufacturers Page 5

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Part 6: Brand Family Identification and Certification
A. Brand Family(s):
The Tobacco Product Manufacturer seeks to certify the following brands and brand families,
and accepts escrow responsibility for all cigarettes or RYO sold in Virginia under these
brand names (attach supplemental pages if needed):
Units Sold
Actual and/or Previous Fabricator
Rolled
Brand Family
in Virginia
(If different from Tobacco Product
Cigarettes or
And Style
In Previous
Manufacturer)
RYO?
Calendar Year
Total:
• For each Brand Style, actual packaging must be included with the original Certification
submitted to the Attorney General. If the Tobacco Product Manufacturer has previously
submitted such packaging and such packaging has not been changed, no resubmission is
required.
□
Tobacco Product Manufacturers previously submitted packaging for each brand family has
not been changed.
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