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Certification of Tobacco Product Importer
Accepting Joint and Several Liability with
Non-Participating Manufacturer for Escrow Compliance in New Mexico and Appointing
Resident Agent for Service of Process
s Certification must be executed by an officer of the Importer with authority to bind
the Importer to the requirements of New Mexico law as stated below. Execution of this
declaration is an assertion that all information provided below is true and correct, and
that the Importer accepts and agrees to all the terms specified below
1. Tobacco Product Importer Identification:
Company Full Legal Name:_____________________________________________
Type of Business Entity (check one):
Sole Proprietorship
General Partnership
Limited Partnership
Limited Liability Company
Other (specify):_____________________________________________
State/Country where created, incorporated or registered:_______________
ude the following with this Certification:
A copy of the current Articles of Incorporation, Certificate of Limited
Partnership, Articles of Organization, or comparable applicable document,
including any amendments, must be attached to the certification.
A copy of the Importer’s current Tobacco Importer’s Permit issued by the
United States Alcohol and Tobacco Trade Bureau, with any amendments.
Trading As (list ALL names used): _______________________________________________
Federal Employers Identification Number: _________________________________________
Federal Tobacco Importer Permit Number: _________________________________________
Physical Address: __________________________________________________________
Mailing Address: __________________________________________________________
Company Phone: __________________________________________________________
Contact Person: __________________________________________________________
Title: __________________________________________________________
Phone: ___________________ Fax: ________________________________________
Email: ________________________________________________________________
Website: ________________________________________________________________
For purposes of this Certification, NMSA, 1978, §7-12-2(H) defines Manufacturer as a person that manufactures,
fabricates, assembles, processes or labels a cigarette or that imports from outside the United States, directly or
indirectly, a finished cigarette for sale or distribution in the United States.
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Title and Dates of Service of ALL Current and Past Officers, Directors and/or Partners:
If t
he Tobacco Product Importer is represented by outside counsel for the purpose of
compliance with NMSA 1978, §§ 6-4-12 through 6-4-24, provide the following
Firm: ________________________________________________________________
Attorney: ________________________________________________________________
Address: ________________________________________________________________
Phone: _______________________________ Fax:_________________________
Email: ________________________________________________________________
2. Impor
ting Contract Information:
The I
mporter identified above imports into the United States cigarettes manufactured by:
Tobacco Product Manufacturer’s Name: _______________________________________
The c
igarette brands imported by the Importer for the Manufacturer identified above are as
follows: ___________________________________________________________________
The I
mporter imports these cigarettes under: (check one)
itten contract commencing_________________ and expiring_________________
contract or informal agreement
3. Acceptance of
joint and several liability:
In accordance with NMSA 1978, § 6-4-17 D (1) of the New Mexico Statutes for all sales
brands of cigarettes identified above which occur in New Mexico, the Importer hereby
accepts joint and several liability with the Tobacco Product Manufacturer identified above for
deposit of all escrow due, payment of all penalties imposed and all costs and attorney's fees
imposed in accordance with NMSA 1978, §§ 6-4-12 through 6-4-24. This liability shall apply
to all sales in New Mexico commencing January 1, 2010 and continuing until ninety days
after written revocation of this acceptance is received by the New Mexico Office of the
Attorney General.
4. Appoint
ment of resident for service of process in New Mexico:
In acc
ordance with NMSA 1978, § 6-4-17 D (2) of the New Mexico Statutes, the Importer
hereby appoints the resident agent in New Mexico below as its agent for service of process
on whom all process, and any action or proceeding against it concerning or arising out of the
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enforcement of NMSA 1978, §§ 6-4-12 through §§ 6-4-24 may be served in any manner
authorized by law:
ent: ________________________________________________________________
Company: ________________________________________________________________
Address: ________________________________________________________________
Phone: ____________________ Fax:_________________________
ail: __________________________________________________
A current statement from the registered agent certifying service in this capacity must be
attached to the certification.
5. Execut
ion of Certification:
I he
reby affirm that all the information stated in this declaration is true and correct, and I
hereby commit the Importer identified above to all the terms of this declaration
Signature of Declarant)
(Printed Full Name of Declarant)
(Title of Declarant as Officer of Importer)
City/County of _______________________, State of _________________________
Subscribed and Affirmed before me on this date: ____________________________
Signature: _________________________ Printed Name: _____________________
Notary Public
commission expires: _______________________________
il this originally, fully executed Certification, including all attachments and supporting
documents to:
Mexico Office of the Attorney General
Litigation Division - Tobacco Project
P. O. Drawer 1508
Santa Fe, NM 87504-1508