OFFICE OF THE ATTORNEY GENERAL Lawrence G. Wasden Consumer Protection Division 954 W. Jefferson, 2nd Floor P.O. Box 83720 Boise, ID 83720-0010 Phone: (208) 334-2424 Idaho Non-Participating Manufacturer Initial Response ________________________________________________________________________ Part 1: Date of Submission _________________ ________________________________________________________________________ Part 2: Non-Participating Manufacturer (hereafter NPM Applicant) Identification NPM Applicant’s Name: __________________________________________________________ Concurrent with the submission of this form, the NPM Applicant has submitted its Idaho NonYes No Participating Manufacturer Certificate of Compliance. Name of Person Completing Initial Response Form: ___________________________________ Title of Person Completing Initial Response Form: ____________________________________ ________________________________________________________________________ Part 3: Information Request A. All NPM Applicants Provide the information requested. On separate sheets of paper, respond to each question or indicate N/A. All attachments must indicate the request number to which it corresponds. 1. A complete list of Cigarettes that the NPM Applicant manufactures, no matter where sold; time periods for manufacture of those Brand Families and the place of manufacture of those Brand Families. 2. A complete list of other tobacco products (e.g. cigars, pipe tobacco, smokeless tobacco, etc.) that the NPM Applicant manufactures, no matter where sold; time periods for manufacture of those Brand Families; and the place of manufacture of those Brand Families. 3. A list of prior manufacturers, if any, of each of the Brand Families listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form. IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE–1 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com 4. For each Brand Family listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form, provide the following: a. The date manufacturing first commenced or is intended to commence. b. Explanation of the manufacturing process that constitutes fabrication of the listed Brand Families. c. The name, physical address, and factory contact where the Brand Families are or will be manufactured. 5. If the NPM Applicant previously imported or distributed Cigarettes in the U.S., list each Brand Family name and the manufacturer’s name and address for each Brand Family. 6. If the NPM Applicant delivers or plans to deliver Cigarettes directly to an Idaho Stamping Agent, list all such Stamping Agents. If the NPM Applicant does not sell directly to Idaho Stamping Agents, provide a list of all importers and/or distributors to which Cigarettes were or will be sold during the sales year indicated. 7. For each Brand Family of roll-your-own tobacco being certified, state whether the NPM Applicant pays the Idaho OTP tax and provide a complete list of retailers to whom the rollyour-own tobacco is intended to be sold in Idaho. 8. If the NPM Applicant intends to sell or authorize any other entity to sell any Cigarettes by mail order or through the Internet, provide the Internet website and identify the entity. Attach copies of all reports, if any, filed with the Idaho State Tax Commission to comply with Jenkins Act (Chapter 10A of Title 15 of the U.S. Code, Section 375 et seq.) for sales in the last 12 months. Attach copies of any agreement authorizing another to sell your Brand Families by mail order or through the Internet. 9. For each Brand Family (cigarettes only) listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form, provide the name and address of the entity that submitted the ingredient reporting information to the U.S. Secretary of Health and Human Services as required by the Federal Cigarette Labeling and Advertising Act (15 U.S.C. §1335a) and attach copies of all certificates of compliance. 10. For each Brand Family (cigarettes only) listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form, provide a copy of the current FTC rotation plan approval letter and the name and address of the entity that filed the health warning rotation plan with the FTC. 11. Provide a list of States that have certified the NPM Applicant and the Brand Families certified. If any State has refused to list or removed the NPM Applicant or a Brand Family of the NPM Applicant from a State’s directory, identify the State(s). IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE–2 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com B. NPM Applicants Located in Foreign Countries. Provide the information requested. On separate sheets of paper, respond to each question or indicate N/A. All attachments must indicate the request to which it corresponds. 1. Provide copies of all Custom Form 7501s for the sales year indicated for each Brand Family listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form. 2. Provide a copy of the sworn statement that the NPM Applicant has timely submitted or has certified that it will timely submit ingredients to the Secretary of Health and Human Services as required by 19 U.S.C. §1681a (c)(1). 3. Provide a copy of the importer’s certificate under penalty of perjury as required by 19 U.S.C. §1681a (c)(2) regarding the precise format of warnings and the rotation plan for health warnings. 4. Provide a copy of the trademark holder’s certificate under penalty of perjury that it has not withdrawn consent to import into the United States as required by 19 U.S.C. §1681a (c)(3)(A) and a copy of the importer’s certificate under penalty of perjury that the trademark owner has not withdrawn consent into the Unites States as required by 19 U.S.C. §1681a (c)(3)(B). 5. List the name, address, and contact information for all importers for the Brand Families listed in Part 3 of the Idaho Non-Participating Manufacturer Certificate of Compliance form. ________________________________________________________________________ Part 4: Authorized Designee and Representation Under penalty of perjury, I certify and declare that all of the statements and information contained in this Initial Response form, including attachments, are true, correct, accurate and complete in every particular, and that I am a person authorized to bind the NPM Applicant identified in Part 1, under either the laws of the State of Idaho or of the jurisdiction where the NPM Applicant resides or is organized. Any violation of these requirements is a basis for removal of the NPM Applicant and/or its Brand Families from the Directory. Authorized Designee: ___________________________________ Title: ____________________ Signature of Designee: ______________________________________ Date: Subscribed and sworn to before me on this date: ______________ ______________________________________ Signature of Notary Public: ________________________________________________________ City or County of: ______________________________________________________________ Printed Name of Notary Public: My Commission expires: __________________________________________________ _______________________________________________________ Seal: IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE–3 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com OFFICE OF THE ATTORNEY GENERAL Lawrence G. Wasden Consumer Protection Division 954 W. Jefferson, 2nd Floor P.O. Box 83720 Boise, ID 83720-0010 Phone: (208) 334-2424 Instructions for the Idaho Non-Participating Manufacturer Initial Response General Information Who must file an Idaho Non-Participating Manufacturer Initial Response? Any Non-Participating Manufacturer (NPM Applicant) who has not previously been certified by the Idaho Attorney General and whose Cigarettes are or will be sold in the State of Idaho, whether directly or through any distributor, retailer, or similar intermediary, must execute and deliver to the Office of the Attorney General an Idaho Non-Participating Manufacturer Initial Response form (Initial Response Form). Please note: The Initial Response Form is in addition to an NPM Applicant submitting the Idaho NonParticipating Manufacturer Certificate of Compliance (Certification). In addition, after being certified, NPM Applicants must submit to the Idaho Attorney General either Idaho’s Certificate of Escrow Funding Compliance or Idaho’s Quarterly Certificate of Escrow Funding Compliance, as applicable. Both of the escrow funding certificate forms, as well as the Certification, and information about their applicability and when they must be filed are located at: http://www.ag.idaho.gov. When is the Initial Response Form due? If an NPM Applicant has not previously submitted a Certification to the Idaho Office of the Attorney General, it must submit a Certification and an Initial Response Form to the Attorney General, and the Attorney General must certify that its status as an NPM Applicant and the Brand Family(ies) it manufactures before its Cigarettes can be sold in Idaho. Thereafter, an NPM Applicant that has been certified and had its Brand Families certified by the Attorney General must annually submit its Certification on or before April 30th of the year following the year in which sales were made. To whom must the Initial Response Form be delivered? Mail the original Initial Response Form and a complete copy of all supporting documents to: OFFICE OF THE ATTORNEY GENERAL Consumer Protection Unit 954 W. Jefferson, 2nd Floor P. O. Box 83720 Boise, ID 83720-0010 Attention: Tobacco Enforcement IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE INSTRUCTIONS–1 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com If convenient, a signed Report may be scanned and e-mailed to: tobaccoenforcement@ag.idaho.gov. Definitions 1 (a) “Brand Family” has the same meaning given the term in Idaho Code § 39-8402(1) and includes all styles of Cigarettes sold under the same trademark and differentiated from one another by means of additional modifiers or descriptors, including, but not limited to, “menthol,” “lights,” “kings,” and “100s.” (b) "Cigarette" has the same meaning given the term in Idaho Code § 39-7802(d), and includes any product that contains nicotine, is intended to be burned or heated under ordinary conditions of use, and consists of or contains (1) any roll of tobacco wrapped in paper or in any substance not containing tobacco; or (2) tobacco, in any form, that is functional in the product, which, because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette; or (3) any roll of tobacco wrapped in any substance containing tobacco which, because of its appearance, the type of tobacco used in the filler, or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a cigarette. The term "cigarette" includes "roll-your-own" tobacco (i.e., any tobacco which, because of its appearance, type, packaging, or labeling is suitable for use and likely to be offered to, or purchased by, consumers as tobacco for making cigarettes). For purposes of this definition of "cigarette," 0.09 ounces of "roll-your-own" tobacco shall constitute one (1) individual "cigarette." (c) “Directory” means the Directory of Compliant Tobacco Product Manufacturers and Brand Families as provided for by Idaho Code § 39-8403(2). (d) "Master Settlement Agreement" has the same meaning given the term in Idaho Code § 397802(e) and includes the settlement agreement (and related documents) entered into on November 23, 1998, by Idaho and leading United States tobacco companies. (e) “Non-Participating Manufacturer” has the same meaning given the term in Idaho Code § 398402(5) and includes any Tobacco Product Manufacturer that is not a Participating Manufacturer. (f) “Participating Manufacturer” has the same meaning given the term in Idaho Code § 39-8402(6) and includes any Tobacco Product Manufacturer that has joined the Master Settlement Agreement. (g) “Stamping Agent” has the same meaning given the term in Idaho Code § 39-8402(8) and includes a person who: (1) is authorized to wholesale Cigarettes; or (2) is required to affix tax stamps to packages or other containers of Cigarettes under Title 63, Chapter 25, Idaho Code; or (3) pays a tobacco products tax on roll-your-own tobacco. (h) "Tobacco Product Manufacturer" has the same meaning given the term in Idaho Code § 397802(i) and includes an entity that directly manufactures Cigarettes anywhere that such 1 Defined terms are capitalized throughout these instructions and the Certification. IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE INSTRUCTIONS–2 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com manufacturer intends to be sold in the United States, including Cigarettes intended to be sold in the United States through an importer Specific Instructions Part 1: Date of Submission. Indicate the date of submission. Part2: NPM Applicant's Identification. Identify the NPM Applicant. Confirm that the Idaho Non-Participating Manufacturer Certificate of Compliance (Certification) is also being submitted. The Office of the Attorney General cannot proceed with review and certification until the NPM Applicant has submitted both its Certification and its Initial Response Form. Part 3: Information Request. Section A requests information that every NPM Applicant must provide. On separate sheets of paper, each request must be responded to either with the requested information or “N/A.” All attachments must indicate the request number to which it corresponds. Section B requests information that every NPM Applicant located in a foreign country must provide. On separate sheets of paper, each request must be responded to either with the requested information or “N/A.” All attachments must indicate the request number to which it corresponds . Part 4: Authorized Designee Signature and Representation. The person executing the Initial Response Form must be authorized to bind the NPM Applicant. The authorized designee’s name and title must be printed, and the Initial Response Form must be executed in the presence of an authorized notary. IDAHO NON-PARTICIPATING MANUFACTURER INITIAL RESPONSE INSTRUCTIONS–3 of 3 (revised 3/7/2008) American LegalNet, Inc. www.FormsWorkFlow.com