Form Dbpr Abt-6024 - Application For Cigarette/tobacco Wholesaler, Tobacco Exporter, Or Cigarette Distributing Agent Page 9

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FOR DIVISION USE ONLY – DO NOT WRITE BELOW THIS LINE
Trade Name (D/B/A)
CODE:
FEIN NUMBER
City_____________ County___________________
TYPE
FEE
TOTAL _________________________
Approved by______________________________ Date_________Audited:_________ Unaudited:________
District Office Received Date Stamp
District Office Accepted Date Stamp
9

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