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This document is a report form from the Vermont Department of Taxes that licensed tobacco distributors must complete monthly. It requires distributors to provide information about cigarette and roll-your-own tobacco brands sold in Vermont that were made by tobacco companies not participating in the 1998 Master Settlement Agreement. The form collects the brand names, number of cigarettes or ounces of roll-your-own tobacco sold, and the manufacturers and suppliers of these non-participating brands. Distributors must sign and certify that the information provided is complete and accurate before submitting it with their wholesale cigarette or tobacco tax reports.

