Form CTP-123 "Brand Summary List for Foreign Manufactured/Imported Cigarette Products" - Wisconsin

What Is Form CTP-123?

This is a legal form that was released by the Wisconsin Department of Revenue - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2007;
  • The latest edition provided by the Wisconsin Department of Revenue;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CTP-123 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Revenue.

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Download Form CTP-123 "Brand Summary List for Foreign Manufactured/Imported Cigarette Products" - Wisconsin

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State of Wisconsin
Participating or Non-Participating Manufacturer Certification - Brand Summary
Foreign Manufactured Cigarettes IMPORTED into the United States (U.S.) for Sale in the U.S.
Page
of
Foreign Manufacturer Name
Authorized Importer Name(s)
Certification for Sales Year
Authorized Importer’s Federal Permit No. Authorized Importer’s WDOR Permit No.
- TI -
CIMP -
TIMP -
COMPLETE BRAND SUMMARY LIST
List all brands manufactured by you and available for sale to consumers on the U.S. market, on or after May 23, 2000. Failure to disclose all brands on this certification is cause for delisting and/or denial of
listing for all attributed brands. NOTE: Following the initial certification, the manufacturer must update its list thirty (30) days prior to any addition to, modification of, its Brand Families by executing and
delivering a supplemental Certification Form to the Attorney General and the Department of Revenue.
Cigarette: As defined in 995.10(1)(d), (Wis. Stats.)
Brand Family: As defined in 995.12(1)(a), (Wis. Stats.)
IMPORTED BRANDS – Brands manufactured outside the United States (U.S.) for sale in the U.S. by the manufacturer above and imported under the federal permit above. Attach all corresponding
Brand Certification Schedules in alpha/numeric order (i.e. A-1, A-2, B-1, B-2, C-1, C-2, etc.).
Instructions: List all brands in alphabetical order for each category. A Cigarettes [first]; B Roll-Your-Own Tobacco (RYO) [next]; and C Little Cigars [last].
Brand
Product Type
*
**
***
Reference No.
Cigarette [first]
X
[Enter A-1,
RYO [next]
Brand Family
Other Manufacturers
Brand Name
Brand Style
A-2, B-1, ...]
Little Cigars [last]
(e.g. King, 100’s, Light, etc.)
*
Mark with an “X” each brand that you request brand certification for sale of that product.
Include with your certification, one package or one bag of each brand (any style) of Cigarettes, RYO, or Little Cigars you are seeking to certify.
**
A Participating Manufacturer shall not include a Brand Family in its certification, unless the Participating Manufacturer affirms that the Brand Family is to be deemed to be its cigarettes for the purpose of
calculating payments under the Master Settlement Agreement for the relevant year, in the volume and shares determined pursuant to the Master Settlement Agreement. Nothing in this Certification shall
limit or otherwise affect the State’s right to maintain that a Brand Family constitutes cigarettes of a different tobacco product manufacturer for purposes of calculating payment under the Master Settlement
Agreement.
***
Identify other manufacturers including, but not limited to, any other current or previous fabricators of any brands or brand families listed on this certification.
CTP-123 (R. 3-07)
Wisconsin Department of Revenue
FYI - click mouse in 'Page' field to begin and tab throughout. Use
Print
Clear
mouse, spacebar, or enter key to check boxes.
State of Wisconsin
Participating or Non-Participating Manufacturer Certification - Brand Summary
Foreign Manufactured Cigarettes IMPORTED into the United States (U.S.) for Sale in the U.S.
Page
of
Foreign Manufacturer Name
Authorized Importer Name(s)
Certification for Sales Year
Authorized Importer’s Federal Permit No. Authorized Importer’s WDOR Permit No.
- TI -
CIMP -
TIMP -
COMPLETE BRAND SUMMARY LIST
List all brands manufactured by you and available for sale to consumers on the U.S. market, on or after May 23, 2000. Failure to disclose all brands on this certification is cause for delisting and/or denial of
listing for all attributed brands. NOTE: Following the initial certification, the manufacturer must update its list thirty (30) days prior to any addition to, modification of, its Brand Families by executing and
delivering a supplemental Certification Form to the Attorney General and the Department of Revenue.
Cigarette: As defined in 995.10(1)(d), (Wis. Stats.)
Brand Family: As defined in 995.12(1)(a), (Wis. Stats.)
IMPORTED BRANDS – Brands manufactured outside the United States (U.S.) for sale in the U.S. by the manufacturer above and imported under the federal permit above. Attach all corresponding
Brand Certification Schedules in alpha/numeric order (i.e. A-1, A-2, B-1, B-2, C-1, C-2, etc.).
Instructions: List all brands in alphabetical order for each category. A Cigarettes [first]; B Roll-Your-Own Tobacco (RYO) [next]; and C Little Cigars [last].
Brand
Product Type
*
**
***
Reference No.
Cigarette [first]
X
[Enter A-1,
RYO [next]
Brand Family
Other Manufacturers
Brand Name
Brand Style
A-2, B-1, ...]
Little Cigars [last]
(e.g. King, 100’s, Light, etc.)
*
Mark with an “X” each brand that you request brand certification for sale of that product.
Include with your certification, one package or one bag of each brand (any style) of Cigarettes, RYO, or Little Cigars you are seeking to certify.
**
A Participating Manufacturer shall not include a Brand Family in its certification, unless the Participating Manufacturer affirms that the Brand Family is to be deemed to be its cigarettes for the purpose of
calculating payments under the Master Settlement Agreement for the relevant year, in the volume and shares determined pursuant to the Master Settlement Agreement. Nothing in this Certification shall
limit or otherwise affect the State’s right to maintain that a Brand Family constitutes cigarettes of a different tobacco product manufacturer for purposes of calculating payment under the Master Settlement
Agreement.
***
Identify other manufacturers including, but not limited to, any other current or previous fabricators of any brands or brand families listed on this certification.
CTP-123 (R. 3-07)
Wisconsin Department of Revenue