Office of the Vermont Attorney General

Compliance Officer Form

2018 Compliance Officer Form

Vermont Office of Attorney General

109 State Street
Montpelier, VT 05609-1001

Due Date: January 1, 2019

Section 1: Manufacturing Company
Contact Information
City
State/Province
Zip/Postal
Section II: Compliance Officer
Contact Information
City
State/Province
Zip/Postal
Section III: Data Collection and Reporting, If different from Compliance Officer, check if same
Section IV: Filing
Select your own username and password
Section V: Declaration

I certify that the information stated by me in this disclosure is true and accurate to the best of my knowledge. I understand that providing false information or omission of information is unlawful.

Submit this form electronically - DO NOT MAIL.
Please send a a check made out to State of Vermont for $500 to: Office of the Attorney General, Attn: Public Protection Division, 109 State Street, Montpelier, VT 05609-1009 by January 1, 2019