Form Tob: Sch D - Manufacturers Not Participating In The Tobacco Master Settlement Agreement Page 2

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PART II – PARTICIPATING MANUFACTURER – Complete this section for participating manufacturer’s brands.
• SEE INSTRUCTIONS SHEET • USE ADDITIONAL FORMS IF NEEDED
A
B
C
D
E
F
G
H
Conversion of
Number of
Roll-Your-Own Ounces to
Participating Manufacturer’s Full
Importer’s Full
Brand Code
Brand Name
Individual Cigarettes
Ounces of
Total Units Sold
+
Name and Address
Name and Address
(Units Sold)*
Roll-Your-Own**
Cigarette Units Sold
(Col. E
G)
÷
(Col. F
0.09)

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