1. (1) Brand ___________________________________ Sub-brand _____________________
2. (2) Most Recent Nicotine Level Reported to the FTC ________________________________
3. (3) Total Nicotine Content in Cigarette Tobacco (Milligrams) _________________________
4. (4) pH of Smoke ________________________ Percent Filter Ventilation __________
5. (5) Nicotine Delivery under Average Smoking Conditions ___________________________

6. (6) Classification ___________________________ Number of Puffs _________________

   (>1/2 milligrams.: high; >0.2-1.2: moderate; .01-0.2: low; <.01: nicotine free)

   _________________________________________

   Smokeless Tobacco Nicotine Yield Rating Form

7. (1) Brand ___________________________________ Sub-brand _____________________

8. (2) Moisture Content in Percent _________________ Nicotine as a Percent of Dry Weight

   Tobacco _______________________

9. (3) Nicotine in Milligrams per Gram of Tobacco ___________________________________
10. (4) pH _____________________________________________________________________
11. (5) Total Unionized (free) Nicotine ______________________________________________
12. (6) Classification ____________________________________________________________

(>2.0 milligrams: high; >0.5-2.: moderate; 0.1-0.5: low; <0.01: nicotine free)

REGULATORY AUTHORITY

105 CMR 660.000: M.G.L. c. 94, § 307B.

(PAGES 3867 AND 3868 ARE RESERVED FOR FUTURE USE.)