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Non-Participating Manufacturers Request For Units Sold Information Form. This is a Tennessee form and can be use in Attorney General Statewide.
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Tags: Non-Participating Manufacturers Request For Units Sold Information, Tennessee Statewide, Attorney General
STATE OF TENNESSEE
OFFICE OF THE
ATTORNEY GENERAL
TOBACCO ENFORCEMENT DIVISION
P. O. BOX 20207
NASHVILLE, TENNESSEE 37202-0207
NON-PARTICIPATING MANUFACTURER’S
REQUEST FOR “UNITS SOLD” INFORMATION
I.
Company Information
(a) Non-Participating Manufacturer:_________________________________________
(b) Address:____________________________________________________________
(c) Telephone:___________________________________________________________
(d) Fax:________________________________________________________________
(e) Authorized Representative Making Request:________________________________
II.
Request for “Units Sold” Information
On behalf of the above-identified Non-Participating Manufacturer,
____________________________________, hereby request that the Tennessee Office of
(Authorized Representative)
Attorney General Tobacco Enforcement Division (hereinafter the “State”), disclose the number
of “Units Sold”, as defined at Tenn. Code Ann. § 47-31-102(10), for the following brand
families:_____________________________________________________, sold in Tennessee
(NPM Brand Families)
during the following time period:__________________.
(year/quarter)
By executing this request form, I acknowledge that the State has the authority to revise its
calculation of the number of Units Sold if any new or amended information is received at any
time. I further acknowledge that the above-identified Non-Participating Manufacturer is required
to track its sales occurring in Tennessee in accordance with Tenn. Code Ann. § 47-31-103.
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III.
Manufacturer’s Totals for Units Sold During ______________________________
(Year/Quarter)
(Please fill out a separate line for each brand family sold by a wholesaler)
Name and Address of Wholesalers
licensed in Tennessee to whom tobacco
products were shipped.*
Brand Family Sold
Number of Units
Shipped
*This also applies to wholesalers located out-of-state who are licensed to do business as a
Tennessee wholesaler.
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III.
Confidentiality Agreement
On behalf of the above-identified Non-Participating Manufacturer, I,
_____________________________________, hereby agree not to disclose the Units Sold
(Authorized Representative)
information provided by the State in response to this request, including wholesaler data collected
by the Tennessee Department of Revenue, to anyone other than employees and representatives
of the above-named Non-Participating Manufacturer.
IV.
Signature
__________________________________
Authorized Representative
___________________________________
Date
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