IDAHO STAMPING AGENT QUARTERLY REPORT Page 1 of 3 (revised 3/8/2018) 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 STAMPING AGENT QUARTERLY REPORT PART 1: STAMPING AGENT INFORMATION AND REPORTING PERIOD Check ONE Box: 2018 Other Year: January 1 226 March 31 April 1 226 June 30 July 1 226 September 30 October 1 226 December 31 Company Name: d/b/a: Idaho State Tax Commission Permit Number: Mailing Address: Phone: FAX: Email Address: Name of Person Completing Report: PART 2: SALES INFORMATION AND CERTIFICATION You Must Check at Least One Box: ALL Sales of Participating Manufacturer Cigarettes (including roll-your-own tobacco) are shown in Part 3. Included separately in the appropriate sections are all Idaho tax exempt sales to Indian Reservations and all other Idaho tax exempt sales. ALL Sales of Non-Participating Manufacturer Cigarettes (including roll-your-own tobacco) are shown in Part 4. Included separately in the appropriate sections are all Idaho tax exempt sales to Indian Reservations and all other Idaho tax exempt sales. ALL Cigarettes sold were purchased with Idaho State tax stamps previously affixed, or, in the case of roll-your-own tobacco, the Idaho tobacco products tax already paid, by: (Name of entity that product was purchased from) NO Cigarettes (including roll-your-own tobacco) were sold during the specified quarter. I certify that I am authorized to sign this document and that the information contained herein is correct to the best of my knowledge. Signature of Stamping Agent or Representative Date For Office Use Only American LegalNet, Inc. www.FormsWorkFlow.com IDAHO STAMPING AGENT QUARTERLY REPORT Page 2 of 3 (revised 3/8/2018) PART 3: PARTICIPATING MANUFACTURERS (ATTACH ADDITIONAL SHEETS IF NEEDED) IDAHO STAMPED/IDAHO TOBACCO PRODUCT TAX PAID (UNITS SOLD) IDAHO TAX EXEMPT INDIAN RESERVATION SALES OTHER IDAHO TAX EXEMPT SALES** A Brand Family/ Tobacco Product Manufacturer B Entity Purchased From C Number of STAMPED Cigarettes Sold D RYO Sold (ounces/.09) E Number of Cigarettes Sold F RYO Sold (ounces/.09) G Number of Cigarettes Sold H RYO Sold (ounces/.09) ** For each sale reported in columns G and H, on separate sheets of paper identify the basis for the tax exempt status claimed, such as military reservation sales, and the entity to whom the specific Cigarettes or RYO tobacco were sold. American LegalNet, Inc. www.FormsWorkFlow.com IDAHO STAMPING AGENT QUARTERLY REPORT Page 3 of 3 (revised 3/8/2018) PART 4: NON-PARTICIPATING MANUFACTURERS (ATTACH ADDITIONAL SHEETS IF NEEDED) IDAHO STAMPED/IDAHO TOBACCO PRODUCT TAX PAID (UNITS SOLD) IDAHO TAX EXEMPT INDIAN RESERVATION SALES OTHER IDAHO TAX EXEMPT SALES** A Brand Family/ Tobacco Product Manufacturer B Entity Purchased From C Number of STAMPED Cigarettes Sold D RYO Sold (ounces/.09) E Number of Cigarettes Sold F RYO Sold (ounces/.09) G Number of Cigarettes Sold H RYO Sold (ounces/.09) ** For each sale reported in columns G and H, on separate sheets of paper identify the basis for the tax exempt status claimed, such as military reservation sales, and the entity to whom the specific Cigarettes or RYO tobacco were sold. American LegalNet, Inc. www.FormsWorkFlow.com IDAHO STAMPING AGENT QUARTERLY REPORT INSTRUCTIONS Page 1 of 4 (revised 3/8/2018) INSTRUCTIONS FOR THE IDAHO STAMPING AGENT QUARTERLY REPORT General Information Who must file an Idaho Stamping Agent Quarterly Report? All 223Stamping Agents224 must file the Idaho Stamping Agent Quarterly Report. Please note: For purposes of reporting to the Idaho Attorney General, a Stamping Agent is defined broadly by Idaho law to mean a person who: (1) is permitted by the Idaho State Tax Commission to wholesale (as that term is defined by Idaho222s cigarette excise tax laws) 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. This definition of Stamping Agent includes anyone that holds a Cigarette Permit or Tobacco Permit issued by the Idaho State Tax Commission, regardless of current activity involving 223the act of stamping224 cigarette packages or the making of tobacco sales. The Stamping Agent222s duty to file the attached report is in addition to a permitted stamping agent222s obligation, as applicable, to file monthly Idaho Cigarette or Tobacco Products Tax Returns with the Idaho State Tax Commission. When is the Idaho Stamping Agent Quarterly Report due? Idaho Stamping Agents must file the attached report on a quarterly basis. These reports are due twenty (20) days after the end of each quarter as set out below. Quarter Report Due Date January 1 226 March 31 April 20 April 1 226 June 30 July 20 July 1 226 September 30 October 20 October 1 226 December 31 January 20 If a due date falls on a weekend or a holiday, the due date moves to the next business day. To whom must the Idaho Stamping Agent Quarterly Report be delivered? Mail the signed, original Report, with attachments as applicable, to: OFFICE OF THE ATTORNEY GENERAL Consumer Protection Division 954 W. Jefferson, 2nd Floor P.O. Box 83720 Boise, ID 83720-0010 Attention: Tobacco Enforcement If convenient, a signed Report may be scanned and e-mailed to: tobaccoenforcement@ag.idaho.gov . American LegalNet, Inc. www.FormsWorkFlow.com IDAHO STAMPING AGENT QUARTERLY REPORT INSTRUCTIONS Page 2 of 4 (revised 3/8/2018) DEFINITIONS1 (a) 223Brand Family224 has the same meaning given the term in Idaho Code 247 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, 223menthol,224 223kings,224 and 223100s.224 (b) 223Cigarette224 has the same meaning given the term in Idaho Code 247 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 223cigarette224 includes 223roll-your-own224 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 223cigarette,224 0.09 ounces of 223roll-your-own224 tobacco shall constitute one (1) individual 223cigarette.224 (c) 223Master Settlement Agreement224 has the same meaning given the term in Idaho Code 247 39 7802(e) and includes the settlement agreement (and related documents) entered into on November 23, 1998, by Idaho and leading United States tobacco companies. (d) 223Non-Participating Manufacturer224 has the same meaning given the term in Idaho Code 247 39 8402(5) and includes any Tobacco Product Manufacturer that is not a Participating Manufacturer. (e) 223Participating Manufacturer224 has the same meaning given the term in Idaho Code 247 39 8402(6) and includes any Tobacco Product Manufacturer that has joined the Master Settlement Agreement. (f) 223Stamping Agent224 has the same meaning given the term in Idaho Code 247 39-8402(8) and includes a person who: (1) is permitted by the Idaho State Tax Commission to wholesale (as that term is defined by Idaho222s cigarette excise tax laws) 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. (g) 223Tobacco Pr