Maine > Statewide > Attorney General > Tobacco
Quarterly Distributor Report Of Tobacco Sales In Maine - Maine
| Quarterly Distributor Report Of Tobacco Sales In Maine Form. This is a Maine form and can be used in Tobacco Attorney General Statewide . |
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Maine Attorney General ATTN: Vivian Mikhail 6 State House Station Augusta, Maine 04333-0006 Telephone (207)626-8494 Fax (207)624-7730 QUARTERLY DISTRIBUTOR REPORT OF TOBACCO SALES IN MAINE _ _ to _ _ *Note: This report must be filed on or before the 20th day of the month following the end of the reporting period. REPORTING QUARTER AND YEAR: from Distributor Name: ________________________________________________ Address: _______________________________________________________ City, State, Zip: __________________________________________________ Distributor License No.:_______________________________ Telephone No:______________________________________ Contact phone: _____________________________________ Contact: ________________________________________________________ Contact email:______________________________________ PARTICIPATING MANUFACTURER AND BRAND INFORMATION: Brand name Number of cigarettes sold within the state Ounces of rollyour own tobacco sold within the state Participating manufacturer name Who paid Maine tax on product / affixed tax stamps to product? ("U" or "A") Us or Another Person/entity from whom brand was purchased (if this person/entity paid tax or affixed stamp indicate by asterisk) To whom did you sell product? If to another distributor, provide name and address. If at retail indicate "retail" Cigarette and RYO brands not listed together with the manufacturer on Maine's Manufacturer and Brand Directories may NOT be sold in Maine. Both directories are available on the Attorney General's website at http://www.maine.gov/ag/health_issues/tobacco.shtml. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com NON-PARTICIPATING MANUFACTURER AND BRAND INFORMATION: Who paid Maine tax on product / affixed tax stamps to product? ("U" or "A") Us or Another Brand name Number of cigarettes sold within the state Ounces of rollyour own tobacco sold within the state Non-participating manufacturer name Person/entity from whom brand was purchased (if this person/entity paid tax or affixed stamp indicate by asterisk) To whom did you sell product? If to another distributor, provide name and address. If at retail pursuant to a retail license indicate by "retail" To be completed by person completing this form: PRINT NAME:_____________________________________________ SIGNATURE:________________________________________________ DATE:______________________ JOB TITLE:________________________________ If you have questions about filling out this form please contact Vivian Mikhail, AAG, at (207) 626-8494. Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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