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Brand Families Unit Sales Schedule Form. This is a Connecticut form and can be use in Department Of Revenue Services Statewide.
Tags: Brand Families Unit Sales Schedule, TPM-3, Connecticut Statewide, Department Of Revenue Services
Form TPM-3
State of Connecticut
Calendar year
2010
Brand Families Unit Sales Schedule
Sales Made During Calendar Year 2010
This form must be submitted with the 2010 Form TPM-1, Certification of Compliance and Affidavit by Nonparticipating Manufacturer.
(Rev. 03/11)
Company is a (Check one.)
Complete this form in blue or black ink only.
Manufacturer
Importer
Check if this is an amended form.
Department of Revenue Services (DRS) Cigarette Manufacturer License Number
Company name
City, town, or post office
State or province
Telephone number
Facsimile (FAX) number
Email address
(
(
Company address
Number and street
)
PO Box
Country
)
Part I - Instructions
Column A:
List all brand families sold during calendar year 2010. Indicate by asterisk (*) any brand family no longer sold in Connecticut as of the date this form is signed.
Column B:
Product type codes
Enter C for any brand family of cigarettes.
Enter RYO for any brand family of roll-your-own tobacco. Each 0.09 ounce of roll-your-own tobacco constitutes one stick.
Enter LC for any brand family of little cigars that are properly treated as cigarettes for the purposes of the federal excise tax on cigarettes (26 U.S.C. §5701(b)).
Column C:
List the total sticks sold in Connecticut during calendar year 2010.
Column D:
If the reporting company is not the manufacturer (the fabricator), provide the name, address, and Federal Employee Identification Number (FEIN) of the manufacturer.
Part I - Total sales made to consumers within Connecticut, whether directly or through a distributor, dealer, or similar intermediary or intermediaries, during calendar year 2010
Column A
Brand Family Name(s)
Column B
Product Type Codes
Column D
Manufacturer (Fabricator) Name, Address, and FEIN
Column C
Total Sticks
Attach additional sheet(s) as necessary to provide a complete response.
Complete Part II and Declaration on Page 2.
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State of Connecticut
Form TPM-3
Brand Families Unit Sales Schedule
Sales Made to Date During Calendar Year 2011
Company name
Department of Revenue Services (DRS) Cigarette Manufacturer License Number
Part II - Instructions
Column A:
Column B:
Column C:
Column D:
List all brand families that have been sold to date during calendar year 2011 to consumers within Connecticut.
Product type codes
Enter C for any brand family of cigarettes.
Enter RYO for any brand family of roll-your-own tobacco. Each 0.09 ounce of roll-your-own tobacco constitutes one stick.
Enter LC for any brand family of little cigars that are properly treated as cigarettes for purposes of the federal excise tax on cigarettes (26 U.S.C. §5701(b)).
List the total sticks sold to date during calendar year 2011 to consumers within Connecticut.
If the reporting company is not the manufacturer (the fabricator), provide the name, address, and Federal Employee Identification Number (FEIN) of the manufacturer.
Part II - Sales made to date during calendar year 2011 to consumers within Connecticut, whether directly or through a distributor, dealer, or similar intermediary or intermediaries
Column A
Brand Family Name(s)
Column B
Product Type Codes
Column D
Manufacturer (Fabricator) Name, Address, and FEIN
Column C
Total Sticks
Attach additional sheet(s) as necessary to provide a complete response.
Declaration: Under penalty of perjury under the laws of Connecticut, I declare that I am authorized to certify on behalf of the reporting company named above and all of the information
contained in this form is complete and accurate.
Signature of company officer
Date
Print name of company officer
Email address
Print title of company officer
Form TPM-3, Part II (Rev. 03/11)
Telephone number
Fax number
Page 2 of 2
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