Idaho Activity For Nonparticipating Cigarette Brands {CG1501-NP}

Name: Tax Period: Permit Number: EIN: CG 1501-NP Tobacco Master Settlement AgreementIdaho State Tax CommissionIdaho Activity for Nonparticipating Cigarette BrandsUse this schedule to report the cigarettes purchased from nonparticipating manufacturers and then stamped and sold in Idaho. You must complete this schedule in additionand brands online, go to www2.state.id.us/ag/consumer/tobacco/directoryindex.htm. For more information on the Tobacco Master Settlement Agreement, please visit the Idaho Attorney General222s Web site at www2.state.id.us/ag/consumer/tobacco/msa.htm. a. BrandNamec.QuantityPacks of 20d.Total Cigarettes(Col c. X 20)e.QuantityPacks of 25f.Total Cigarettes(Col. e. X 25)EFO0014412-11-06 b. Nonparticipating Manufacturer222sName & Address Total Column d. Total Column f. þ GRAND TOTAL Columns d. + f. þ CERTIFICATION: I certify that I am authorized to sign this document and that the information contained here is correct to the best of my knowledge. Date þ Printed Nameþ Signature Total Column d. from additional page(s) Total Column f. from additional page(s) American LegalNet, Inc. www.FormsWorkFlow.com CG 1501-NP Idaho Activity for Nonparticipating Cigarette Brands (page 2)Use this schedule to report any additional nonparticipating cigarette brands stamped and sold participating manufacturers and brands online, go to www2.state.id.us/ag/consumer/tobacco/directoryindex.htm. a. BrandNamec.QuantityPacks of 20d.Total Cigarettes(Col. X 20)e.QuantityPacks of 25f.Total Cigarettes(Col. e. X 25)EFO0014412-16-08 b. Nonparticipating Manufacturer222sName & Address Total Column d. Total Column f. þ Carry the Total for Column d. and the Total for Column f. to the front page. American LegalNet, Inc. www.FormsWorkFlow.com