STATE OF NEVADA OFFICE OF THE ATTORNEY GENERAL 5420 Kietzke Lane, Suite 202 Reno, NV 89511 PARTICIPATING MANUFACTURER (PM) CERTIFICATE OF COMPLIANCE FORM B&TD-TOB1 NOTE: The State of Nevada will not process incomplete or illegible certifications. Page 1 of 7 NVAGO 226 Tobacco Unit Form Revised: 03/1/2019 PART I : TOBACCO PRODUCT PARTICIPATING MANUFACTURER IDENTIFICATION 2019 PM CERTIFICATE OF COMPLIANCE CHECK CERTIFICATION TYPE: INITIAL ANNUAL SUPPLEMENTAL A.Company Information Company Name Mailing Address City/State/Zip/Country Telephone Number E - Mail Address Website Additional Website , if owned Name/Title of Company Contact Company Contact E - Mail Address Address of Manufacturing Plant(s) City/State/Zip/Country Phone Number of Factory If located in U . S.: Manufactur er222s Federal Taxpayer ID number (FEIN) If located in U . S . : TTB Tobacco Manufacturer 222s Permit Number Expires Nevada Manufacturer 222s License Number Date of Issuance Note: The contact information, including e-mail address, listed above will be used for all official correspondence from the Nevada Attorney General222s Office. The PM is responsible for updating its contact information with the Nevada Attorney General222s Office if it changes during the course of the year. American LegalNet, Inc. www.FormsWorkFlow.com PM CERTIFICATE OF COMPLIANCE FORM B&TD-TOB1 NOTE: The State of Nevada will not process incomplete or illegible certifications. Page 2 of 7 NVAGO 226 Tobacco Unit Form Revised: 03/1/2019 B. Company Officers and Owners Provide a complete list of the PM222s officers and owners. For the purposes of this section, an owner is considered any person with an equity interest of 10% or more in the company. This information may be provided in an attached exhibit. EXHIBIT Officer/Owner Name Title Address City/State/Zip/Country E - mail Address Telephone Number Fax Number Officer/Owner Name Title Address City/State/Zip/Country E - mail Address Telephone Number Fax Number Officer/Owner Name Title Address City/State/Zip/Country E - mail Address Telephone Number Fax Number Officer/Owner Name Title Address City/State/Zip/Country E - mail Address Telephone Number Fax Number C. Corporate or Business Documents Attach current copies of articles of incorporation (include background information such as date of initial formation and state involved), corporate charters, certificates of corporate existence, operating agreements, and bylaws, as applicable to corporate status. If the PM previously submitted these organizing documents to the Nevada Attorney General and these documents have not changed since that submission, do not re-submit. EXHIBIT Check here if no changes have been made to the PM222s organizing documents. American LegalNet, Inc. www.FormsWorkFlow.com PM CERTIFICATE OF COMPLIANCE FORM B&TD-TOB1 NOTE: The State of Nevada will not process incomplete or illegible certifications. Page 3 of 7 NVAGO 226 Tobacco Unit Form Revised: 03/1/2019 D. Manufacturers Permits, Licenses, and Disclosures NOTE: Check "N/A" boxes below if no changes have been made to previously submitted documents. 1. If the PM is located in the United States (223U.S.224), attach a copy of the PM222s current TTB manufacturer222s or importer222s permit(s), copies of a map(s) clearly depicting the physical location of TTB-permitted manufacturing/fabrication plant(s) involved, and photographs of the plant(s) interior, preferably showing tobacco manufacturing/fabrication equipment . EXHIBITS & N/A 2. If the PM is located outside of the U.S., provide copies of a current Importer222s Permit issued by the TTB that is used in connection with the importation of the PM222s tobacco product(s). Also provide copies of any manufacturing or importer licenses, certificates, permits or similar documents issued by the country where the PM tobacco product manufacturing takes place. Include copies of a map(s) clearly depicting the physical location of foreign-permitted PM tobacco manufacturing/fabrication plant(s) involved and photographs of the plant(s) interior preferably showing tobacco manufacturing/fabrication equipment. EXHIBITS & N/A 3. If the brand families to be listed for sale in Nevada are manufactured or fabricated by another entity other than the PM, please provide the other entity222s name, address and contact information and a copy of any agreement or contract between the PM and this company regarding the manufacture/fabrication and/or sale of each brand family. EXHIBITS & 4. If the PM manufactures any tobacco products, other than those listed in Part II (A) 1-2, for any other entity, please provide the other entity222s name, address, contact information, and tobacco product brand names involved. EXHIBITS & PART II : BRAND FAMILY IDENTIFICATION A. 2018 Brand Identification (PM Annual Certification Only) List all brand families sold by the PM in 2018. This information may also be attached. EXHIBIT Brand Family Name Cigarettes or RYO Brand Family Name Cigarettes or RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO American LegalNet, Inc. www.FormsWorkFlow.com PM CERTIFICATE OF COMPLIANCE FORM B&TD-TOB1 NOTE: The State of Nevada will not process incomplete or illegible certifications. Page 4 of 7 NVAGO 226 Tobacco Unit Form Revised: 03/1/2019 B. 2019 Brand Identification for 2019 Directory Listing for All PM Certifications List all brand families intended for sale in Nevada during 2019 and the Nevada Fire Standard Certification expiration date. This information may also be attached. EXHIBIT Brand Family Name Cigarettes or RYO NV FSC Expiration Date Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Cigarette RYO Provide a sample of the packaging of each brand family listed above. EXHIBIT American LegalNet, Inc. www.FormsWorkFlow.com PM CERTIFICATE OF COMPLIANCE FORM B&TD-TOB1 NOTE: The State of Nevada will not process incomplete or illegible certifications. Page 5 of 7 NVAGO 226 Tobacco Unit Form Revised: 03/1/2019 B. 2019 Brand Compliance with Federal and State Requirements 1. For each cigarette brand family, provide a list of styles to be sold in Nevada in 2019 along with a copy of a current Fire Standard Compliant Cigarette Certificate issued by the Nevada State Fire Marshal for each style. All style names must match the styles listed on the Nevada Fire Standard Compliant Certificate. EXHIBIT 2. Provide a copy of the current Federal Trade Commission (FTC) approval letter(s) for health- warning rotation plan for all brand families. Info: http://www.ftc.gov . EXHIBIT 3. Provide a copy of the current Centers for Disease Control (CDC) ingredient-listing compliance letter(s) pertaining to the above brands of cigarettes. Info: http://www.cdc.gov . EXHIBIT 4. For each brand family, provide a copy of all licensed trademarks. If any brand trademarks are owned by someone other than the NPM, provide a copy of a current trademark use agreement signed by all parties involved. EXHIBIT Check if no changes to previously submitted trademarks. Do not resubmit. 5. Provide a current listing of all Universal Product Code (UPC) numbers associated with each brand family listed above. Ensure the listing includes the UPC numbers for packs, cartons and cases. EXHIBIT Check if no changes to previously submitted UPC numbers. Do not resubmit. 6. Provide the contact information below for all Nevada licensed distributor the PM intends to use in 2019 for distribution in Nevada. Alternatively, this information may be provided in an attached exhibit. EXHIBIT Distributor Name Contact Name/Title Distributor Address Distributor Phone Distributor Name Contact Name/Title Distributor Address Distributor Phone Distributor Name Contact Name/Title Distributor Addres