Oklahoma Business Registration Application Page 4
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5Oklahoma Business Registration Application
Business Name
FEIN/SSN
Section 7
Cigarette/Tobacco License:
If you are applying for any type of tobacco license, questions 29-34
must be
answered. If answers to
questions below are found to be incomplete or incorrect, license can be revoked.
29. Do you owe $500.00 or more in delinquent cigarette taxes? . . . . . . . . . . . . . . . Yes No
30. Have you had a cigarette manufacturer, retailer or distributor
license revoked by the Oklahoma Tax Commission in the past two years? . . . .
Yes No
31. Have you been convicted of a crime relating to stolen or counterfeit cigarettes? . .
Yes No
32. If you are applying as a cigarette manufacturer, please check true or false
in regards to the statements below:
A. “I am a participating manufacturer as defined in Section II (jj) of the Master
Settlement Agreement as defined in Section 600.22 of Title 37 of the
Oklahoma Statutes.” . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
True
False
OR
B. “I am in full compliance with the provisions of paragraph 2 of
subsection A of Section 600.23 of Title 37 of the Oklahoma Statutes.” . . . . . True False
33. If you are applying as a cigarette manufacturer, are any of the cigarettes
you will be importing into the United States in violation of 19 U.S.C.,
Section 1681a? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
34. If you are applying as a cigarette manufacturer, are any of the cigarettes
you will be importing or manufacturing not in compliance with the Federal
Cigarette Labeling and Advertising Act, 15 U.S.C., Section 113 et seq.? . . . . . .
Yes No
Section 8
Signature:
A sole owner, general partner, responsible corporate officer, member, or authorized representative
must sign this application.
I, the undersigned applicant or authorized representative, or if a corporation, a responsible corporate officer for the
reporting and remitting of taxes, declare under the penalities of perjury that I have examined this application and
attachments and to the best of my knowledge the facts set forth are true and correct, and that the requirements
hereunder will be carried out in accordance with the laws of the State of Oklahoma and the rules and regulations of
the Oklahoma Tax Commission. I further acknowledge and agree that sales, withholding and motor fuel taxes are
trust funds for the State of Oklahoma and that any use of these trust funds other than timely remittance to the State of
Oklahoma is embezzlement and can result in criminal prosecution.
Type or print name
Sign Name
Type or print title
Date
/
/
Month
Day
Year
Mandatory inclusion of Social Security and/or Federal Employer Identification Number is required on forms filed with
the Oklahoma Tax Commission pursuant to Title 68 of the Oklahoma Statutes and regulations thereunder, for iden-
tification purposes, and are deemed part of the confidental files and record of the Oklahoma Tax Commission. The
Oklahoma Tax Commission is not required to give actual notice of changes in any state tax law.
D
Application continued on page E...
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