Non Participating Manufacturers Application Annual Certification

2024 NON-PARTICIPATING MANUFACTURER’S APPLICATION/ANNUAL CERTIFICATION FORM. THE SALES YEAR FOR WHICH YOU ARE CERTIFYING COMPLIANCE IS 2023. FILING DEADLINE: Certification Forms must be postmarked no later than April 30, 2024 to avoid removal from the North Carolina Tobacco Directory. Please Type or Print. The Attorney General’s Office will not process incomplete or illegible Certification Forms. An application will be deemed incomplete if the applicant(s) is/are under a NC Revenue Suspension, the applicant(s) certificate of authority to transact business is revoked, or the applicant(s) fail(s) to obtain a certificate of authority from the NC Secretary of State when required by law. This Certification Form must be supplemented to reflect any change in information at any time during the year. Any change of information must be submitted 30 days prior to change. The failure to notify the Attorney General’s Office of any changes to this information 30 days prior to any change, including changes in address, may result in removal from the North Carolina Tobacco Directory. The denial of a certification, removal of the Applicant or its brands from any other state’s tobacco directory, or failure to notify the North Carolina Attorney General’s Office of same, may, in the Attorney General’s sole discretion, result in denial of this certification or immediate removal from the North Carolina Tobacco Directory. ESCROW DEPOSIT DUE DATES: April 15, 2024 is the escrow deposit due date for Nonparticipating Manufacturers (NPMs) subject to Annual Escrow Deposits. April 30, 2024 is the First Quarter Due date for NPMs subject to Quarterly Escrow Deposits. www.FormsWorkflow.com