Compliance Certification (Yearly Escrow Deposits RYO Tobacco Sales)

COMPLIANCE CERTIFICATION BY NON-PARTICIPATING MANUFACTURER (YEARLY ESCROW DEPOSIT MADE IN 2024 FOR 2023 RYO SALES). This form is used by non-participating manufacturers (NPMs) to certify their compliance with Virginia's escrow requirements for roll-your-own (RYO) tobacco sales. It confirms that the manufacturer has deposited the required escrow funds for RYO tobacco sold in Virginia during the 2023 sales year. Under the Master Settlement Agreement (MSA) and Virginia law, these escrow deposits serve as financial assurances for potential future state costs related to tobacco-related health care expenses. The form requires the manufacturer to provide identifying details, including its name, address, and contact information. It also mandates reporting the total number of ounces of RYO tobacco sold in Virginia and converting that figure into "units sold," with one unit equaling 0.09 ounces. The escrow deposit amount is then calculated based on the adjusted per-unit rate for 2023. Additionally, the form includes sections for financial institution details, proof of deposit, and an affidavit certifying the accuracy of the information. A fully executed form, along with supporting documentation, must be submitted to the Virginia Attorney General’s Office by April 30 of the year following the sales year. www.FormsWorkflow.com