STATE OF NEW MEXICO Non-Participating Manufacturer’s Sales Information NPM SUPP. A Manufacturer Identification Company Name Mailing Address City State Phone Name and title of person completing this form Date: Zip Code Fax Country E-Mail: Mail-to Address (if different from above) Name Mailing Address City Phone State Fax Zip Code E-mail Country Liability Year □ 2011 □ Other: Manufacturer’s Records (attach Addendum pages as necessary) Instructions for the Manufacturer: List each distributor which sells your product(s) in the State of New Mexico. For each distributor, provide the sales volume according to your records for each brand family for the liability year and provide copies of invoices or other documents that support the sales volume listed. In addition, provide the name, address and contact person for all distributors to whom you sold product for the liability year. You must retain all invoices and documentation of sales and other information relied upon for a period of 5 years, unless otherwise required by law to maintain them for a greater period of time. By completion of this form, the Manufacturer identified above requests that the Attorney General: ▪ compare the brand sales volume below to that which distributors have reported to the Attorney General; ▪ determine whether an escrow payment based on the manufacturer’s reported sales volume Represents adequate funding for the liability year Sales Volume Dist. Reported Distributor Brand Family Check Manufacturer’s As of _____ One Records (AG use only) □ □ □ □ □ □ cigarette RYO cigarette RYO cigarette RYO Total of RYO Ounces Total of Cigarette Sticks Rev. 11-18-10 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF NEW MEXICO Non-Participating Manufacturer’s Sales Information NPM SUPP. A Manufacturer Identification Company Name Sales Addendum Page ____ of _____ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ 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 Total of RYO Ounces Total of Cigarette Sticks Rev. 11-18-10 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF NEW MEXICO Non-Participating Manufacturer’s Sales Information NPM SUPP. A Manufacturer Identification Company Name Sales Addendum Page ____ of _____ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ □ 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 Total of RYO Ounces Total of Cigarette Sticks Rev. 11-18-10 American LegalNet, Inc. www.FormsWorkFlow.com