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OFFICE OF THE ATTORNEY GENERAL (Maryland Attorney General)

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Form MDOAG- MSA 1B
STATE OF MARYLAND
OFFICE OF THE ATTORNEY GENERAL
BRAND FAMILY IDENTIFICATION FORM
Complete a copy of this form for each Brand Family of cigarettes and Roll-Your-Own tobacco
that the Manufacturer is submitting for certification in the State of Maryland.
A. Name of Brand Family: __________________________
B. Trademark Information:
1. Provide the Trademark Registration number assigned by the United States Patent
and Trademark Office for this brand. Reg. # ____________________________
2. Identify the owner of the trademark of this brand. ________________________
3. If the brand owner is not the certifying TPM, is the owner an affiliate of the
certifying TPM? □ Yes. □ No.
a. If Yes, indicate the relationship between the owner and the certifying TPM.
b. If No, provide a copy of all manufacturing or licensing agreements that grant
the TPM the right to manufacture and/or market the brand in the United States.
4. If the brand is not registered with the USPTO, provide the legal basis for the
TPM’s assertion of ownership over the brand.
C. Styles of this brand family have been certified by the Office of the Comptroller as
Fire Safety Standards Compliant within the past three years, pursuant to Md. Code
Ann., Bus. Reg. §§ 16-601 et. seq. □ Yes □ No □ N/A
D. The Federal Trade Commission has approved the health warning rotation plan for
each cigarette style of this brand family. □ Yes □ No □ N/A
E. The Centers for Disease Control and Prevention has approved the ingredient listing
for this brand family of cigarettes. □ Yes □ No □ N/A
F. Provide a physical or digital representation of the packaging for each brand style.
Form MDOAG- MSA 1B
G. Identify all brand styles of cigarettes and RYO that are being certified. For each style,
indicate if it is: 1) currently on the directory and being renewed; 2) a new brand style
to be added; or 3) a discontinued style to be removed from the directory. Attach
additional pages if necessary.
Brand Style
Current New Discontinued
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OFFICE OF THE ATTORNEY GENERAL (Maryland Attorney General)

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Completed 14 August 2020

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