Form Reg-1 Draft - Addendum A Cigarette And Tobacco Products Taxes Page 2

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Part II: Tobacco products other than cigarettes (Tobacco products licenses expire June 30 of each year).
Tobacco products distributor: Any person in
Connecticut
engaged in the business of:
1.
Manufacturing tobacco
products;
2.
Purchasing untaxed tobacco products at wholesale from manufacturers or other distributors for
sale; or
3.
Importing into this state untaxed tobacco products, at least 75% of which are to be sold.
Any of these is required to be licensed by DRS as a tobacco products
distributor.
Untaxed tobacco products mean tobacco products (as defi ned in Part I) purchased from persons not licensed by DRS as tobacco products distributors.
These are tobacco products on which the Connecticut tobacco products tax has not been paid.
Unclassifi ed importer: Any person, other than a tobacco products distributor, who imports, receives, or acquires untaxed tobacco
products from outside this state for his or her personal use or consumption in this
state.
/
/
If you check any of the boxes in Part II, enter the date that you will start purchasing untaxed tobacco products
__ __
__ __
__ __ __ __
m m
d d
y y y y
Schedule A: Description and Location of Vending Machines Attach list if necessary.
Make of Machine
Model Number
Name and Complete Address of the Premises Where Machines Are Located
Schedule B: Retail Store Locations of Chain Store Distributors Attach list if necessary.
Tax Registration Number
Name and Complete Address of Retail Store
or DRS Use Only
F
Authorized signature
Date
Effective date
Bond amount
REG-1 Addendum A (Rev.
)
Page 2 of 3
03/15
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20150316 4:00 PM

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