2018 Non-participating Manufacturer Quarterly Certificate of Compliance Form - West Virginia

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S
W
V
TATE OF
EST
IRGINIA
Non-Participating Manufacturer
Quarterly Certificate of Compliance
Pursuant to W.Va. Code § 16-9D-6(e)
Part 1: Tobacco Product Manufacturer Identification
Company Name:
Street Address:
City:
State/Country:
Postal Code:
Telephone:
Fax Number:
Email:
Name and Title of Person
Completing this Report:
Part 2: Liability Reporting Period
First Quarter: January 1 through March 31, 2018
May 1, 2018:
Escrow Deposit Due in West Virginia Sub-Account
May 11, 2018:
NPM Quarterly Certificate of Compliance Received by Attorney General
May 11, 2018:
Account letter submitted by bank to the Attorney General
Second Quarter: April 1 through June 30, 2018
July 31, 2018:
Escrow Deposit Due in West Virginia Sub-Account
August 10, 2018:
NPM Quarterly Certificate of Compliance Received by Attorney General
August 10, 2018:
Account letter submitted by bank to the Attorney General
Third Quarter: July 1 through September 30, 2018
October 31, 2018:
Escrow Deposit Due in West Virginia Sub-Account
November 12, 2018:
NPM Quarterly Certificate of Compliance Received by Attorney General
November 12, 2018:
Account letter submitted by bank to the Attorney General
Fourth Quarter: October 1 through December 31, 2018
January 31, 2019:
Escrow Deposit Due in West Virginia Sub-Account
February 11, 2019:
NPM Quarterly Certificate of Compliance Received by Attorney General
February 11, 2019:
Account letter submitted by bank to the Attorney General

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