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AG PM-1 LY2021 updated 22422.pdf
Certification: (check one) Initial Annual Supplemental
Part 2: Manufacturer Identification
Company Name FEIN
Mailing Address
City State Zip Code Country
Phone Fax Web Address
Name and title of person completing this form
Part 3:...
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AG NPM-R Reconciliation Affidavit LY2024 updated 1.24.2025.pdf
Affidavit of Non-Participating Manufacturer
Regarding Escrow Reconciliation Payment
NPM-R
Part 1: Manufacturer Identification Part 2: Liability Year
Name: The liability period for this Affidavit is:
Street Address: 2024 Due Apr.15, 2025
Part 3:...
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AG NPM-R Reconciliation Affidavit LY2023 updated 3.1.24.pdf
Affidavit of Non-Participating Manufacturer
Regarding Escrow Reconciliation Payment
NPM-R
Part 1: Manufacturer Identification Part 2: Liability Year
Name: The liability period for this Affidavit is:
Street Address: 2023 Due Apr.15, 2024
Part 3:...
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AG NPM-R Reconciliation Affidavit LY2022 updated 3.1.23.pdf
Affidavit of Non-Participating Manufacturer
Regarding Escrow Reconciliation Payment
NPM-R
Part 1: Manufacturer Identification Part 2: Liability Year
Name: The liability period for this Affidavit is:
Street Address: 2022 Due Apr.15, 2023
Part 3:...
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AG NPM-R Reconciliation Affidavit LY2021 updated 3.3.22.pdf
Affidavit of Non-Participating Manufacturer
Regarding Escrow Reconciliation Payment
NPM-R
Part 1: Manufacturer Identification Part 2: Liability Year
Name: The liability period for this Affidavit is:
Street Address: 2021 Due Apr.15, 2022
Part 3:...
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AG NPM-Q LY2024 updated 1.24.2025.pdf
NPM-Q
p. 1 of 3
Part 1: Liability Reporting Period
The liability period for this affidavit is: (check one)
2024
Jan.-Mar.
Due Apr. 30
Apr.-Jun.
Due Jul. 31
Jul.-Sep.
Due Oct. 31
Oct.-Dec....
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AG NPM-Q LY2023 updated 3.1.24.pdf
NPM-Q
p. 1 of 3
Part 1: Liability Reporting Period
The liability period for this affidavit is: (check one)
2023
Jan.-Mar.
Due Apr. 30
Apr.-Jun.
Due Jul. 31
Jul.-Sep.
Due Oct. 31
Oct.-Dec....
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AG NPM-Q LY2022 updated 3.1.23.pdf
NPM-Q
p. 1 of 3
Part 1: Liability Reporting Period
The liability period for this affidavit is: (check one)
2022
Jan.-Mar.
Due Apr. 30
Apr.-Jun.
Due Jul. 31
Jul.-Sep.
Due Oct. 31
Oct.-Dec....
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AG NPM-Q LY2021 updated 3.1.22.pdf
NPM-Q
p. 1 of 3
Part 1: Liability Reporting Period
The liability period for this affidavit is: (check one)
2021
Jan.-Mar.
Due Apr. 30
Apr.-Jun.
Due Jul. 31
Jul.-Sep.
Due Oct. 31
Oct.-Dec....
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AG NPM-Q Brands Addendum LY2024 updated 1.24.25.pdf
State of Illinois Affidavit of
Non-Participating Manufacturer Regarding
Quarterly Escrow Payment
NPM-Q
Brands
Addendum
Manufacturer Identification
Company Name Brands Addendum Page ___ of ___
Part 3: Brand Sales (Attach addendum pages...
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AG NPM-Q Brands Addendum LY2023 updated 3.1.24.pdf
State of Illinois Affidavit of
Non-Participating Manufacturer Regarding
Quarterly Escrow Payment
NPM-Q
Brands
Addendum
Manufacturer Identification
Company Name Brands Addendum Page ___ of ___
Part 3: Brand Sales (Attach addendum pages...
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AG NPM-Q Brands Addendum LY2022 updated 3.1.23.pdf
State of Illinois Affidavit of
Non-Participating Manufacturer Regarding
Quarterly Escrow Payment
NPM-Q
Brands
Addendum
Manufacturer Identification
Company Name Brands Addendum Page ___ of ___
Part 3: Brand Sales (Attach addendum pages...
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AG NPM-Q Brands Addendum LY2021 updated 3.1.22.pdf
State of Illinois Affidavit of
Non-Participating Manufacturer Regarding
Quarterly Escrow Payment
NPM-Q
Brands
Addendum
Manufacturer Identification
Company Name Brands Addendum Page ___ of ___
Part 3: Brand Sales (Attach addendum pages...
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AG NPM-PACT updated 3322.pdf
(check one) ☐ 2021 ☐ Other: ______
Type of Certification: (check one) ☐ Initial ☐ Annual ☐ Supplemental
Part 2: Manufacturer Identification
Company Name
Part 3: PACT Act Registration
1....
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AG NPM-PACT updated 3.1.23.pdf
(check one) ☐ 2022 ☐ Other: ______
Type of Certification: (check one) ☐ Initial ☐ Annual ☐ Supplemental
Part 2: Manufacturer Identification
Company Name
Part 3: PACT Act Registration
1....
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AG NPM-LC updated 3.3.22.pdf
Rev. 03/03/2022
State of Illinois
Non-Participating Manufacturer
Certification of Little Cigar/Cigarette
NPM-LC
p. 2 of 2
Part 3:...
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AG NPM-LC updated 3.1.24.pdf
Rev. 03/01/2024
State of Illinois
Non-Participating Manufacturer
Certification of Little Cigar/Cigarette
NPM-LC
p. 2 of 2
Part 3:...
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AG NPM-LC updated 3.1.23.pdf
Rev. 03/01/2023
State of Illinois
Non-Participating Manufacturer
Certification of Little Cigar/Cigarette
NPM-LC
p. 2 of 2
Part 3:...
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AG NPM-LC updated 1.24.2025.pdf
Rev. 01/24/2025
State of Illinois
Non-Participating Manufacturer
Certification of Little Cigar/Cigarette
NPM-LC
p. 2 of 2
Part 3:...
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AG NPM-F LY2024 updated 1.24.2025.pdf
Certification of Additional Information
NPM-F
p. 1 of 2
Part 1: Liability Year and Type of Certification
☐ 2024 ☐ Other ☐ Initial ☐ Annual ☐ Supplemental
Part 2: Manufacturer Identification
Company Name:
Part 3:...