Idaho > Statewide > Office Of Attorney General > Consumer Protection Division
Idaho Quarterly Certificate Of Escrow Funding Compliance - Idaho
| Idaho Quarterly Certificate Of Escrow Funding Compliance Form. This is a Idaho form and can be used in Consumer Protection Division Office Of Attorney General Statewide . |
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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 Quarterly Certificate of Escrow Funding Compliance for 2012 Sales Please note: Non-Participating Manufacturers that are required to make quarterly escrow deposits must use this report. Non-Participating Manufacturers reporting annually instead of quarterly should use the Idaho Annual Certificate of Escrow Funding Compliance form. See the attached instructions for further details regarding which Non-Participating Manufacturers must make quarterly escrow deposits. Part 1: Non-Participating Manufacturer Identification Company Name: _______________________________________________________________ Physical Address: (street address only; no post office box): ______________________________________________________________________________ ______________________________________________________________________________ Mailing Address (if different from above): ______________________________________________________________________________ ______________________________________________________________________________ Phone: ______________________________ FAX: __________________________________ Email Address: _________________________________________________________________ Website Address: _______________________________________________________________ FEIN: ________________________________________________________________________ Name of Person Completing Certification: ___________________________________________ Title: _________________________________________________________________________ Part 2: Quarter Being Reported The sales year for this Idaho Quarterly Escrow Certificate of Escrow Funding Compliance is the calendar year 2012. The quarter being reported is (check one): January 1, 2012 March 31, 2012 July 1, 2012 September 30, 2012 April 1, 2012 June 30, 2012 October 1, 2012 December 31, 2012 IDAHO QUARTERLY CERTIFICATE OF ESCROW FUNDING COMPLIANCE FOR 2011 SALES 1 of 3 (revised 3-9-12) American LegalNet, Inc. www.FormsWorkFlow.com Part 3: Units Sold for Quarter Indicated Indicate the number of Units Sold (an individual cigarette from a pack that bears an Idaho cigarette tax stamp or .09 ounces of roll-your-own tobacco equals one Unit Sold) by the above-named NonParticipating Manufacturer, whether directly or through a distributor, retailer, or similar intermediary or intermediaries for the 2012 quarter indicated in Part 2, and write that amount here: A. _____________________________________ Part 4: Quarterly Escrow Payment Amount Calculate the appropriate quarterly escrow deposit amount. Multiply the number of Units Sold listed in part 3.A. by $0.0291058 and write that amount here. A. _____________________________________ The amount in 4.A is the amount that must be deposited on behalf of the State of Idaho in the abovenamed Non-Participating Manufacturer's Qualified Escrow Fund within 30 days of the end of the quarter specified. Part 5: Financial Institution/Escrow Information Name of Qualified Escrow Fund Financial Institution: ______________________________________ Authorized Escrow Agent Contact Name and Title: _______________________________________ Physical Address: __________________________________________________________________ Mailing Address: __________________________________________________________________ Phone number: ___________________________ Fax number: ___________________________ Qualified Escrow Fund Account Number: ______________________________________________ Qualified Escrow Fund Idaho Subaccount Number: _______________________________________ Idaho Code § 39-7803(b)(1) requires payments to be "adjusted for inflation." Idaho Code § 39-7802(a) defines "adjusted for inflation" as cumulative increases "in accordance with the formula for inflation adjustment set forth in Exhibit C to the Master Settlement Agreement." Each year, this figure increases 3% or the actual inflation rate, which ever is greater. Because the actual inflation rate cannot be determined until the end of 2012, tobacco product manufacturers required to make quarterly escrow payments will be required, in their quarterly escrow payments, to deposit an amount that has been cumulatively adjusted for inflation by 3%. When the adjusted for inflation rate for 2012 has been determined, manufacturers will be advised and then have until April 15, 2013, to deposit any additional money, if necessary, to satisfy the actual adjusted for inflation amount under the Act. The 2012 cumulative adjusted for inflation rate, increased by 3%, is 54.42219%. Multiplying the base escrow deposit amount, $.0188482, by the cumulative adjusted for inflation rate, 54.42219%, equals the cumulative inflation adjustment amount of $.0102576. Adding the base escrow deposit amount, $.0188482, to the cumulative inflation adjustment amount, $.0102576, equals $.0291058. IDAHO QUARTERLY CERTIFICATE OF ESCROW FUNDING COMPLIANCE FOR 2011 SALES 2 of 3 (revised 3-9-12) American LegalNet, Inc. www.FormsWorkFlow.com Attached is a copy of the financial institution's receipt or other proof of deposit from the Escrow Agent of the proper escrow payment. Pursuant to Idaho Code §39-8403(1)(c)(iv)(3) the Office of the Attorney General requires verification from the financial institution of the amount and date of deposit to be attached. Part 6: Certification The above-named Non-Participating Manufacturer certifies that (initial all four): ________ It has previously submitted an Idaho Non-Participating Manufacturer Certificate of Compliance to the Office of the Attorney General. Date submitted: ___________________________ ________ Its Qualified Escrow Fund complies with Idaho Code §§ 39-7802(f) and 39-8403(1)(c); ________ Any escrow funds held or to be held in its Qualified Escrow Fund on behalf of the State of Idaho are or will be held in a separate segregated account, separate and apart from escrow funds held on behalf of any other beneficiary; and ________ There is no security interest, as defined by Idaho Code § 28-1-201(35), that has been granted in or has attached or is otherwise applicable to any escrow funds held or to be held in the NonParticipating Manufacturer's Qualified Escrow Fund on behalf of the State of Idaho. Part 7: Authorized Designee and Representation This document must be signed and dated by an authorized representative of the above-identified
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