Form Tob: App-R - Application For Tobacco Stamping Permit Form - Alabama Page 2
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2Type or Print Signature Name: __________________________________________________________________________________
Title: ________________________________________________________________________________________________________
Sworn to and subscribed before me this the _________ day of_____________________, ___________.
Notary Public: ________________________________________________________________________________________________
7. Do you plan to set aside products for shipment out-of-state?
Yes
No
8. Indicate if you are a
Retailer
Wholesaler or
Manufacturer.
9. List counties in which you plan to do business: ___________________________________________________________________
_____________________________________________________________________________________________________________
10. Do you sell any taxable tobaccos to any person who is not a legitimate retail dealer?
Yes
No
11. Do you sell to anyone under any circumstances any article of tobacco in less than wholesale quantities?
Yes
No
12. How many retail stores do you operate in this State engaged in the sale of taxable tobaccos? ____________________________
13. Do you operate a retail department and a wholesale department engaged in the sale of taxable tobaccos under the same
roof?
Yes
No
14. How many sales representatives do you employ soliciting orders of taxable tobacco? __________________________________
15. What territory do these representatives cover? ____________________________________________________________________
16. How many people do you employ for stamping tobacco? ___________________________________________________________
17. Do you keep a permanent record of all taxable tobaccos received by your firm?
Yes
No
18. How many delivery trucks do you operate? _________________
19. Do you distribute tobacco products to individuals operating their own vehicle(s) for distributing or transporting products
to others?
Yes
No
20. Is your firm one of a chain?
Yes
No
If yes, state the name and location of other stores in this chain located within Alabama: ________________________________
_____________________________________________________________________________________________________________
21. List the name and address of the manufacturers from whom you purchase taxable tobaccos direct (add sheet if needed):
1. __________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________
3. __________________________________________________________________________________________________________
4. __________________________________________________________________________________________________________
5. __________________________________________________________________________________________________________
22. Do you buy taxable tobaccos from other jobbers?
Yes
No
If yes, in what quantities? _______________________
23. We must receive a letter of intent from three (3) of your tobacco manufacturers. These letters must state the
manufacturer’s intent to sell tobacco products to your company and must be mailed to our office directly from the
manufacturer.
Under penalties of perjury, we hereby certify the above information to be true and correct.
Firm: ______________________________________________________________________________________________________________
Signature: __________________________________________________________________________________________________________
(If you are a LLC, and all members Do Not sign the application, complete form TOB: LLC-AUTH)
Type or Print Signature Name: ______________________________________________________________________________________
Title: ______________________________________________________________________________________________________________
Sworn to and subscribed before me this the ________ day of ________________________________, _________.
Notary Public: ____________________________________________________
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