American LegalNet, Inc. www.FormsWorkFlow.com ATT-73 (Rev. 8/12) Georgia Department of Revenue Alcohol and Tobacco Division Telephone: (404) 417-4900 E-mail: ATDIV@dor.ga.gov TO BE FILED BY THE 10TH OF EACH MONTH WHOLESALER'S MONTHLY REPORT OF "NONPARTICIPATING MANUFACTURER" CIGARETTES RECEIVED OR SHIPPED INTO GEORGIA WHOLESALE DISTRIBUTOR CITY STATE LICENSE NO. FOR CALENDAR MONTH/YEAR Select One INSTRUCTIONS: O.C.G.A 10-13-12 effective 4/28/99 directs this Department to ascertain the number of units sold (the number of individual cigarettes sold) in the State each year by "Nonparticipating Manufacturers" (manufacturers and importers of cigarettes who did not sign the Master Settlement Agreement entered into on November 23, 1998 with this State). A list of "Participating Manufacturers" is provided below. The date in parenthesis that follows some of those listed indicates when they became participating manufacturers. These were not on our original Form ATT-73. A complete list of MSA Participating Manufacturers can be found at the following web site: http://www.naag.org/tobaccopublic/library.cfm If you receive cigarettes from a manufacturer or an importer not on this list, you are required to file Form ATT-73 by the 10th of the month following the month which the report is filed. List each "Nonparticipating Manufacturer" once and indicate the total number of individual cigarettes received (In-State Wholesalers) or the total number shipped into Georgia (Out-of-State Wholesalers) during the month. If you receive these cigarettes from another wholesaler who has already affixed the Georgia excise tax stamp, you are not to list them on this report (the wholesaler who stamped these cigarettes should list them on their report). If you do not receive/ship any cigarettes during the month from "Nonparticipating Manufacturers", this report must be filed with "NONE" reported. Please submit online at https://gtc.dor.ga.gov. A copy of all invoices covering these shipments should be attached to this report. Nonparticipating Manufacturer's Name Brand Name Full Address Country Alliance Tobacco Corp. (4/27/2000) Lane Limited Brown & Williamson Tobacco Co Ligget Group, Inc. Commonwealth Brands, Inc. Lignum-2, Inc. Cutting Edge Enterprises, Inc (12/22/2000) Lorillard Tobacco Co. Dhanraj International, Inc. LTD Corporation House of Prince A/S (8/19/1999) Mac Baren Tobacco Co. A/S (4/27/2000) Imperial Tobacco Limited/ ITL (USA ) Limited Monte Paz (Compania Industrial de Tabacos Monte Japan Tobacco International U.S.A., Inc. Paz S.A. (11/30/2000) King Maker Marketing P.T. Djarum Landmark Corporation (4/27/2000) Peter Stokkebye International A/S (6/00/1999) Philip Morris, Inc. Planta Tabax-manufaktur Gmbh & Co. (4/27/2000) Number of Individual Cigarettes Ounces of RollYour-Own Tobacco Premier Marketing, Inc. R. J. Reynolds Tobacco Co. Santa Fe Natural Tobacco Co, Inc. Sherman 1400 Broadway N.Y.C., Inc. Societe Nationale d'Exploitation Industrielle des Tabacs et Allumettes (Seita) The Medallion Company, Inc. Tobacco Exporters International (USA) Ltd. (TEl) Tobacco & Candy International, Inc. for Coronado Brand only (9/5/2000) Top Tobacco, L.P. American LegalNet, Inc. www.FormsWorkFlow.com