Wyoming Department of Revenue Cigarette Wholesalers & Other Tobacco Wholesalers, Cigarette Importer, Cigarette Manufacturer License Application An application and license is required for each business location. A Ten dollar ($10.00) License Fee must accompany each application.

Excise Tax Division Herschler Building 122 West 25th Street Cheyenne, WY 82002-0110 Phone: (307) 777-5542 Web site: http://revenue.state.wy.us

Remittance to be made payable to: Department of Revenue Department Use Only: License No:____________________ Date Issued:____________________

Date Business began Wholesaling Cigarettes & or Other Tobacco Products in Wyoming: ______________ Wyoming Sales Tax License Number: _______________________ Business Name or DBA: ____________________________________________________________________ Business Location: ________________________________________________________________________________ Street Address

City: ____________________________________ State: __________________ Zip: ___________________ Business Phone Number: (______) ______- _________ Fax Number: (______) ______- _________ Mailing Address if Different From Above: _____________________________________________________________________ Type of Ownership: Individual Partnership Corporation Association or Other _____________ Ownership Name __________________________________________________________ (Specify) 1. Will you be purchasing unstamped cigarettes directly from a manufacturer for sale or resale in Wyoming? Yes No 2. Are you a cigarette importer who imports into the United States either directly or indirectly a finished cigarette for sale or distribution in Wyoming? Yes No 3. Are you a cigarette manufacturer who manufactures, fabricates, assembles, processes or labels a No finished cigarette for sale in Wyoming? Yes 4. Will you be purchasing cigars, snuff, or other tobacco products directly from a manufacturer for sale or resale in Wyoming? Yes No 5. Do you sell at retail stamped cigarettes or other tobacco products directly to Wyoming consumers? Yes No If yes, indicate your Wyoming Sales/Use Tax License Number ___________________ The application shall be signed by: The Owner, if business is a sole proprietorship. All partners, if the business is a partnership. Member or manager if LLC. One major officer if corporation. Corporations must attach a complete list of officers. Limited liability companies must attach a complete list of members or managers. Signature:_______________________________________________Title:_____________________________ ETS Form 002(revised 05/12/08)

NOTICE TO WYOMING LICENSED TOBACCO WHOLESALERS This is a joint notice from the Wyoming Department of Revenue Excise Tax Division and the Wyoming Attorney General’s Office Tobacco Settlement Unit. Wyo. Stat. § 39-18-106(a), states in part: Every wholesaler who sells or offers to sell cigarettes, cigars, snuff or other tobacco products in this state must have a license to do so issued by the department. No license or renewal of a license shall be granted under this section unless the wholesaler states in writing, under penalty of false swearing, that he shall comply fully with W.S. 9-4-1201 through 9-4-1209. Of specific note is W.S. 9-4-1207, which requires every Wyoming licensed tobacco wholesaler to file by the 20th of each month following the month of sales the form titled: Wyoming Cigarette and Roll-Your-Own Tobacco Wholesaler Report. This report pertains only to sales of cigarettes and roll-your-own tobacco products. The report might be non-applicable to your operation, if you deal only in cigars or pipe tobacco, but because you hold a wholesale license that allows you to deal in cigarette and roll-your-own tobacco product at any time, you must file the report with the Tobacco Settlement Unit of the Attorney General’s Office, not the Department of Revenue. Signing this form attests to the Department of Revenue your compliance with W.S. 9-4-1201 through 9-4-1209. Once signed, return this form to the Department of Revenue on or before the stipulated deadline. I certify, under penalty of false swearing, that I have read this form, and that I shall fully comply with W.S. 9-4-1201 through 9-4-1209, as it pertains to responsibilities of a Wyoming licensed tobacco wholesaler. ______________________________________________________________________________ Name of Wholesaler License # ______________________________________________________________________________ Address (City, State, Zip) ______________________________________________________________________________ Signature of Authorized Representative Date ______________________________________________________________________________ Printed Name of Authorized Representative and Title Return this form to:

Department of Revenue Excise Tax Division Herschler Bldg., 2nd Floor West Deadline: Must be submitted Cheyenne, WY 82002 with license application. Fax - 307-777-3632 For information from the Tobacco Settlement Unit, contact: Lesley Osen at 307-777-5833

INFORMATION FROM THE ATTORNEY GENERAL’S OFFICE, TOBACCO SETTLEMENT UNIT ABOUT THE DIRECTORY OF CERTIFIED TOBACCO PRODUCT MANUFACTURERS THEIR BRANDS AND BRAND FAMILIES Only those Brands and Brand Families listed in The Directory are permitted to be sold in the State of Wyoming. The Directory is available online at: http://attorneygeneral.state.wy.us/tsu. This directory is updated monthly and the updated list is available at the first of each month on the web page. Wyo. Stat. § 9-4-1205(g) requires the Attorney General to develop, maintain, and make available for public inspection a directory listing all tobacco product manufacturers, along with their brand families, that have provided current and accurate certifications and escrow deposits, conforming to statutory requirements. NOTE: The Attorney General is the only source of compliant status. Companies may represent that they are compliant. Please rely only on the official representation you receive from the Attorney General’s Office. If you have a question about a company or a brand, call us! The Directory includes an alphabetical listing of participating and non-participating manufacturers, along with their respective brands and brand families, listed alphabetically under the manufacturer. The Directory also includes a separate alphabetical index of all brands for ease of reference. This Directory does not apply to manufacturers of smokeless tobacco, or other tobacco products, such as pipe tobacco and cigars. The application is only to manufacturers of cigarettes and roll-your–own tobacco products. Penalties, enforceable by the Attorney General or the Department of Revenue, exist for affixing a stamp to a package or other container of cigarettes of a brand not listed in this Directory, or for selling, offering for sale, or possessing for sale a brand not listed in this Directory. (See Wyo. Stat.§ § 9-4-1205-1208.) Retailers need to be cautioned about purchasing product that is not listed in the Directory. If the product is deemed contraband, it can be confiscated and destroyed. For any question, please contact the following: Lesley A. Osen, Administrator Tobacco Settlement Unit (307) 777-5833 FAX: (307) 777-3435 [email protected]

WYOMING DEPARTMENT OF REVENUE

Herschler Building, 122 West 25th Street Cheyenne, Wyoming 82002-0110

CIGARETTE WHOLESALER’S BOND We, _______________________________________________________________________________________________________ Street address or Box No. ______________________________________________________________________________________ City ___________________________ State __________________________ Zip ________________________ as PRINCIPAL, and _____________________________________________________________________________________________ a corporation organized under the laws of the State of ______________________________ and authorized to do a surety business in the State of Wyoming, as SURETY, are held and firmly bound, jointly and severally unto the State of Wyoming in the penal sum of ________________________________________________ dollars ($_______________________________________) lawful money of the United States, to be paid the Wyoming Department of Revenue, as agent of the State of Wyoming for which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors, or assigns, and each of them, jointly and severally. The above Principal has been licensed as a cigarette wholesaler as provided by Wyoming Statute 39-18-102(a). As a cigarette wholesaler, the Principal is authorized and required to affix stamps, imprints or impressions on each package of cigarette sold or distributed in the State of Wyoming. The condition of this obligation is such that if all payments in other than cash, made by the Principal to the Department of Revenue for the purchase of cigarette stamps are honored when presented for payment, the obligation is void, otherwise to remain in full force and effect. The Surety may terminate its liability after giving written notice to the Department of Revenue. The termination shall become effective thirty (30) days after actual receipt of said notice of termination by the Department of Revenue, however, the Surety’s liability remains in effect for those payments made by the Principal and received by the Department prior to the effective date of the termination. This obligation shall become effective on the _______ day of ___________________, 20___, and shall continue in force until termination in the manner above provided. In witness whereof, we have hereunder set our respective hand and seal this ___________ day of _________________, 20____. _________________________________________________ Name of Principal(s)

_________________________________________________ Corporate Surety

By: ______________________________________________ (Signature - President or Vice President) Title

By: ______________________________________________

_________________________________________________ Secretary of Corporation

Its ______________________________________________

Principal’s Corporate Seal: (If none, so state)

Surety’s Corporate Seal

_________________________________________________ For Department Use Only

________________________________________________ Wyoming Resident Agent

________________________________________________ Agency ________________________________________________ Address ________________________________________________ City County Revised 5/22/03

See Reverse Side for Information and Instructions

RULES AND REGULATIONS OF THE WYOMING DEPARTMENT OF REVENUE Chapter IV, Section 4(b) Bond. (I) A cash or surety bond equal to the face value of the maximum purchase of stamps is required of the wholesaler purchasing cigarette stamps with payment other than cash.

INSTRUCTIONS FOR EXECUTING BONDS 1..

If the principal is a CORPORATION, the signature of the President or Vice President must appear, attested by the Secretary or Assistant Secretary. If signed by any other officer or person, certified evidence of the authority of such officer or person to sign for and on behalf of the principal must be submitted with the bond. Subscript to signature space should indicate the corporate capacity or title of signatory for principal, e.g., President or Vice President.

2.

If the principals are PARTNERS, their individual names shall appear in the body of the bond with the recital that they are doing business as a partnership, e.g., John Doe and James Jones, a partnership, doing business as Hub Trucking Company. However, the signature of a partner is sufficient to bind the partnership. If two or more individuals jointly own the business, but not as partners, the signatures of all such owners are necessary.

3.

If the business is a SOLE PROPRIETORSHIP, the name of the owner should appear in the body of the bond with a recital thereafter of the trade name (if any) of the business, e.g., John Doe, doing business as Hub Transportation. If there is no trade name, the sole proprietorship should be shown as “John Doe.”

4.

The nature of the principal as a legal entity should be clearly shown on the bond, i.e., sole proprietorship, partnership or corporation. Designation of the principal by commercial or trade name only is to be avoided (unless it is the actual name of a corporation). A commercial or trade name should only be used in conjunction with the actual names of the owners of the business, e.g., individual owners, individuals comprising the partnership in the manner indicated in instruction Nos. 2 and 3.

5.

The SURETY on the bond must be a surety company licensed to do business in Wyoming. The bond must be countersigned by the surety’s resident agent with his address indicated below the signature. Persons signing should sign their names in the same identical way as they appear on the Power of Attorney.

6.

The SURETYCOMPANY executing the bond shall attach a duly executed Power of Attorney (or a recently certified copy thereof) showing the authority of the person signing as agent for the surety company, unless such person is the President or Vice President of the surety company. The Power of Attorney must have been executed no earlier than 6 months prior to the effective date of the bond. The copy of the Power of Attorney may be certified by any other qualified person such as a notary public, but the Power of Attorney must be certified by the Secretary of the corporate surety.

7.

The impress of the surety’s corporate seal must be affixed to (a) the bond near the surety’s execution and (b) the certification of the attached Power of Attorney near the surety’s execution. Facsimile seals will be accepted on the bond but are not acceptable on the certification of the attached Power of Attorney.

8.

The Power of Attorney must be acknowledged within six months from the effective date of the bond and must show that authorization is still in effect and not revoked.