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HECTOR BALDERAS

ATTORNEY GENERAL

NPM QUARTERLY ESCROW CERTIFICATION

Certificate of Compliance by Non-Participating Manufacturer Regarding Escrow

Payment

GENERAL INFORMATION: What is the definition of a tobacco product manufacturer?

1. Any entity that manufactures cigarettes and/or roll-your-own tobacco

anywhere, and that said manufacturer intends to be sold in the United States, including

cigarettes to be sold in the United States through an importer;

2. The first purchaser anywhere for resale in the United Sates of cigarettes

manufactured anywhere that the manufacturer does not intend to be sold in the United

States; or

3. A successor of any entity described above.

Who is required to file this certificate of compliance?

Any tobacco product manufacturer which:

(1) sells cigarettes within the state of New Mexico (whether directly or through

any distributor, retailer, or similar intermediary) and;

(2) is not a Participating Manufacturer or Subsequent Participating

Manufacturer, as defined in the tobacco Master Settlement Agreement

executed on 12/23/98 between 46 U.S. States and territories, including

New Mexico, and certain tobacco companies (the MSA).

If you satisfy these requirements, you must file this Certificate of Compliance to report

the units of cigarettes manufactured by you and sold in New Mexico and pay the

amount calculated into your qualified escrow fund.

What is a Non-Participating Manufacturer?

A Non-Participating Manufacturer is any tobacco product manufacturer who has not

signed on to the MSA.

What is a qualified escrow fund?

A non-participating manufacturer must establish a qualified escrow fund. This means

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an escrow arrangement with a U.S. federal or U.S. state-chartered financial institution

having no affiliation with any tobacco product manufacturer and having assets of at

least $1,000,000,000, where such arrangement (1) requires that the financial

institution hold the escrowed funds' principal for the benefit of the State of New

Mexico and other "Releasing Parties" as defined in the Master Settlement

Agreement and (2) prohibits the non-participating manufacturer from using,

accessing, or directing the use of the funds' principal except as consistent with NMSA

1978, Section 6-4-13 (B).

When is this certificate of compliance due?

This certificate of compliance is to be filed quarterly, as follows:

Quarter (January through March) – due April 30 of that year

Quarter (April through June) – due July 30 of that year

Quarter (July through September) – due October 30 of that year

Quarter (October through December) – due January 31 of the next year

following the sales year.

When must I make my escrow payment?

You must deposit all escrow payments into your qualified escrow fund quarterly

by the due date of your certificate of compliance set forth in the paragraph above.

Quarter is due April 30, 2

Quarter is due July 30, 3

Quarter is due October

30 and 4

Quarter is due January 31 of the next year following the sales year.

Attach a copy of your receipt or other proof of deposit from your financial institution to

the signed and notarized Certificate of Compliance. In addition, after you have made

your initial deposit into the qualified escrow fund, forward a copy of the escrow

agreement as executed.

SPECIFIC INSTRUCTIONS:

Part 1: Manufacturer's Identification: Write your name, address, telephone and

fax number.

Part 2: Sales Year 2019: Check the appropriate quarter. 1

Quarter is from

January 1, 2019 to March 31, 2019; 2

Quarter is from April 1, 2019 to June 30,

2019; 3

Quarter is from July 1, 2019 to September 30, 2019; and 4

Quarter is from

October 1, 2019 to December 31, 2019.

Part 3: Units Sold: Write the number of Units Sold in New Mexico for the quarter

indicated. A Unit Sold equals an individual cigarette from a pack that bears a New

Mexico state cigarette excise tax stamp or .09 ounces of roll-your-own tobacco.

Part 4: Deposit Amount: Multiply the Units Sold by the adjusted inflation rate of

$0.0357965 to arrive at the total deposit to be paid into your qualified escrow

account for the applicable sales year. Attach a copy of the financial institution’s

receipt or other proof from the Escrow Agent of the escrow deposit.

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Part 5: Financial Institution Write the name and address of the financial

institution holding your escrow account. Include your escrow account number. Also,

write the total cumulative amount currently in your escrow account.

Part 6: Signature An authorized notary public must also sign and date this

certificate of compliance.

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New Mexico Office of the Attorney General

QUARTERLY Certificate of Compliance by Non-Participating

Manufacturer Regarding Escrow Payment

Part 1: Manufacturer’s Identification:

Name: ___________________________________________________________

Address: ___________________________________________________________

Phone: ___________________________________________________________

Part 2: Sales Year 2019 (check one):

The Quarter being reported for this Certificate of Compliance is:

Quarter:

Part 3: Units Sold:

Indicate the number of Units Sold (an individual cigarette from a pack that bears a New

Mexico state cigarette excise tax stamp or .09 ounces of roll-your-own tobacco equals

one Unit Sold) for the 2019 quarter indicated in Part 2:

Units Sold: _____________________

Part 4: Quarterly Escrow Payment Amount:

Calculate the appropriate quarterly escrow deposit amount. Multiply the

number of Units Sold by $0.0357965 and write that amount here:

Escrow Deposit Amount: _____________________

Attach a copy of the financial institution’s receipt or other proof from the Escrow

Agent of the escrow deposit.

NMSA § 6-4-13(A)(2) requires payments to be “adjusted for inflation.” NMSA § 6-4-12(A) defines “adjusted for

inflation” as “increased in accordance with the formula for inflation adjustment set forth in Exhibit C to the Master

Settlement Agreement.” Each year this figure increases 3% or the actual inflation rate, whichever is greater.

Because the actual inflation rate cannot be determined until the end of 2019, tobacco product manufacturers

required to make quarterly escrow payments will be required, in their quarterly escrow payments, to deposit an

amount that has been cumulatively adjusted for inflation by 3%. When the adjusted for inflation rate for 2019 has

been determined, manufacturers will be advised and then have until April 15, 2020 to deposit any additional

money, if necessary, to satisfy the actual adjusted for inflation amount under the Act. The 2019 cumulative adjusted

for inflation rate, increased by 3%, is 89.91984%. Multiplying the base escrow deposit amount of $0.0188482 by

the cumulative adjusted for inflation rate of 89.91984% equals the cumulative inflations adjustment amount of

$0.0169483. Adding the base escrow deposit amount $0.0188482 to the cumulative inflation adjustment amount

$0.0169483 equals $0.0357965.

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Part 5: Financial Institution:

Name of Institution: ________________________________________________

Address: ________________________________________________

Escrow Fund Acct. No.: ________________________________________________

Escrow Fund New Mexico Subaccount No.: _____________________________________

Total Amount Held: ________________________________________________

Part 6: Signature

Under penalty of perjury, I state that, to the best of my knowledge, all of the information

contained in this Certificate of compliance is true and accurate.

This certificate of compliance must also be signed and dated by an authorized notary

public.

Name of Authorized Agent: __________________________ Title: ________________

Signature of Authorized Agent: _______________________ Date: _______________

Subscribed and sworn to before me on this date: ______________________________

Signature of Notary Public: _______________________________

City or County of: ________________________

My Commission expires: _______________________

Mail this certificate of compliance to:

New Mexico Office of the Attorney General

Litigation Division – Tobacco Project

P.0. Drawer 1508

Santa Fe, NM 87504-1508

Fax: 505-490-4881

Street Address for overnight or hand delivery:

New Mexico Office of the Attorney General

Litigation Division – Tobacco Project

408 Galisteo

Santa Fe, NM 87504

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HECTOR BALDERAS ATTORNEY GENERAL NPM QUARTERLY ESCROW CERTIFICATION (New Mexico Attorey General's Office)

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