Form FSC-2 "Application for Fire Standard Compliant Cigarette Approval by Manufacturer" - Arizona

What Is Form FSC-2?

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

Form Details:

  • Released on November 1, 2017;
  • The latest edition provided by the Arizona Department of Forestry and Fire Management;
  • 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 FSC-2 by clicking the link below or browse more documents and templates provided by the Arizona Department of Forestry and Fire Management.

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Download Form FSC-2 "Application for Fire Standard Compliant Cigarette Approval by Manufacturer" - Arizona

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Department of Forestry and Fire Management
Office of the State Fire Marshal
111o W. Washington Ste. 100
Phoenix, AZ 85007
Main Line (602) 771-1400/Fax (602) 771-1421
APPLICATION FOR FIRE STANDARD COMPLIANT CIGARETTE APPROVAL BY MANUFACTURER
This application must be accompanied by all fees, documents, and information required by Arizona Revised Statutes §37-1401 – 37-1409 and
all rules promulgated thereunder. Please complete this form in its entirety. All fees are non-refundable except as determined by the Arizona
State Fire Marshal.
APPROVAL
CHECK ONE
TYPE OF APPROVAL
APPROVAL FEE
QUANTITY OF BRAND FAMILES
TOTAL INCLUDED
INTIAL APPROVAL
$250 PER EACH BRAND FAMILY
$
3-YEAR RENEWAL
$250 PER EACH BRAND FAMILY
$
MANUFACTURER
COMPANY NAME:
CONTACT PERSON:
FEDERAL EMPLOYER ID NUMBER (EIN):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
FAX NO:
EMAIL ADDRESS:
WEBSITE:
In applying for Fire Standard Cigarettes approval, I certify that the cigarette varieties listed on FSC Certification Forms FSC-2 and FSC-2A that are submitted
together or separately in conjunction with this application comply with Arizona Revised Statutes §41-2170 – 41-2170.08 and all rules promulgated thereunder. By my
signature, I verify that the information on the application and all related forms and/or attachments is true. I understand that knowingly providing a false certification
of the Fire Standard Compliant Cigarettes is a violation of Arizona law and may be subject to civil and criminal penalties.
X___________________________________________________________________________________________________
SIGNATURE OF AUTHORIZED MANUFACTURER REPRESENTATIVE
DATE
X___________________________________________________________________________________________________
PRINTED NAME
TITLE
1
Department of Forestry and Fire Management
Office of the State Fire Marshal
111o W. Washington Ste. 100
Phoenix, AZ 85007
Main Line (602) 771-1400/Fax (602) 771-1421
APPLICATION FOR FIRE STANDARD COMPLIANT CIGARETTE APPROVAL BY MANUFACTURER
This application must be accompanied by all fees, documents, and information required by Arizona Revised Statutes §37-1401 – 37-1409 and
all rules promulgated thereunder. Please complete this form in its entirety. All fees are non-refundable except as determined by the Arizona
State Fire Marshal.
APPROVAL
CHECK ONE
TYPE OF APPROVAL
APPROVAL FEE
QUANTITY OF BRAND FAMILES
TOTAL INCLUDED
INTIAL APPROVAL
$250 PER EACH BRAND FAMILY
$
3-YEAR RENEWAL
$250 PER EACH BRAND FAMILY
$
MANUFACTURER
COMPANY NAME:
CONTACT PERSON:
FEDERAL EMPLOYER ID NUMBER (EIN):
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
FAX NO:
EMAIL ADDRESS:
WEBSITE:
In applying for Fire Standard Cigarettes approval, I certify that the cigarette varieties listed on FSC Certification Forms FSC-2 and FSC-2A that are submitted
together or separately in conjunction with this application comply with Arizona Revised Statutes §41-2170 – 41-2170.08 and all rules promulgated thereunder. By my
signature, I verify that the information on the application and all related forms and/or attachments is true. I understand that knowingly providing a false certification
of the Fire Standard Compliant Cigarettes is a violation of Arizona law and may be subject to civil and criminal penalties.
X___________________________________________________________________________________________________
SIGNATURE OF AUTHORIZED MANUFACTURER REPRESENTATIVE
DATE
X___________________________________________________________________________________________________
PRINTED NAME
TITLE
1
CHECK LIST
(All the following items must accompany the document for the application to be complete):
APPROPRIATE FEE
FIRE STANDARDS COMPLIANT CIGARETTE
MARKING APPROVAL FORM AND ILLUSTRATION OF
CERTIFICATION FORM
PROPOSED MARKING
PAGES _____TO_____
PLEASE SUBMIT FORMS THROUGH EMAIL TO
JBRANT@DFFM.AZ.GOV
OR MAIL THEM TO:
ARIZONA DEPARTMENT OF FORESTRY AND FIRE MANAGEMENT
OFFICE OF THE STATE FIRE MARSHAL
1110 W. WASHINGTON ST. STE 100
PHOENIX, AZ 85007
FSC-2 11/17
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