As part of Act 1073 of 2003, the Office of the Enter the…

As part of Act 1073 of 2003, the Office of the            Enter the number of individual cigarettes sold
Attorney General is required to compile information       quarterly in Arkansas in packages bearing the
about cigarettes and roll-your-own tobacco sold in        excise tax stamp of this state. List only cigarettes
the State.                                                contained in packages to which you affixed the
                                                          excise tax stamp of Arkansas. Do not list cigarettes
Those who should complete this form and submit it         that were purchased with the tax stamp already
quarterly are:                                            affixed.

Any person or entity who has been granted and             Column b:
holds a wholesale cigarette license or permit, or a
wholesale tobacco license or permit, pursuant to          Enter number of ounces of roll-you-own tobacco
Arkansas Code §26-57-215, or any person or entity         sold in Arkansas.
who, as a retailer, purchases tobacco products
directly from a manufacturer or an unlicensed             Column c:
wholesaler or distributor and is therefore liable for
reporting and paying taxes under Arkansas Code            Enter the full brand name of the product sold (do
§26-57-211(a)(1)(B).                                      not abbreviate). Do not break down into sub-
                                                          categories, such as regular, menthol, light, etc. For
Definitions                                               example, for a cigarette named "Alpha Bravo Gold
                                                          Menthol Lights" report on "Alpha Bravo Gold".
"Cigarette" means any product that contains               Do not report as "AB Gold" or "AB Gold Menthol
nicotine, is intended to be burned or heated under        Lights".
ordinary conditions of use, and consists of or
contains (i) any roll of tobacco wrapped in paper or      Column d:
in any substance not containing tobacco; or (ii)
tobacco, in any form, that is functional in the           Enter the name and address of the manufacturer of
product, which, because of its appearance, the type       the brand.
of tobacco used in the filler, or its packaging and
labeling, is likely to be offered to, or purchased by,    Column e:
consumers as a cigarette; or (iii) any roll of tobacco,
which, because of its appearance, the type of             Enter the name and address of the person from
tobacco, used in the filler or its packaging and          whom each brand was purchased if different form
labeling, is likely to be offered to, or purchased by,    the person identified in column d.
consumers as a cigarette described in clause (i) of
this definition.                                          Column f:

The term "cigarette" includes "roll-your-own"             Enter the name and address of the person of the
tobacco (i.e., any tobacco, which, because of its         importer of the brand (if known).
appearance, type, packaging, or labeling, is suitable
for use and likely to be offered to, or purchased by,     Preparation of the schedule
consumers as tobacco for making cigarettes). For
purposes of this definition of "cigarette", 0.09          Enter your business name and address as they
ounces of "roll-your-own" tobacco constitutes one         appear on your Wholesale Cigarette Permit. Also
individual "cigarette".                                   enter a facsimile number, electronic address, and
                                                          the name and telephone number of an individual
"Tobacco product manufacturer" means any person           able to answer questions about your report.
who meets the definitions found in Ark. Code §26-                  If more space is required you may copy this
57-260(a)(9).                                                      form.
                                                                   Return the completed form no later than 20
Instructions for Completing Reverse Side                           days after the close of the reporting quarter.
                                                                   Each report must be signed by an individual
This report must be completed for every brand that                 authorized to speak for your business
is stamped for sale within this state.                             Mail completed schedule to:
                                                                           Jeffrey Weber
Column a:                                                                  Office of the Attorney General
                                                                           323 Center Street, Suite 200
                                                                           Little Rock, AR 72201