Form Crf-008 - Tobacco License Application printable pdf download

Form Crf-008 - Tobacco License Application

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CRF-008 (Rev 05/04)

TOBACCO LICENSE APPLICATION

Georgia

Department

of Revenue

Registration Unit

(Read

Instructions

Before Completing)

P O. Box 49512

Atlanta, Georgia 30359-1512

404-417-4490

FOR OFFICE

STATE TAXPAYER

IDENTIFIER:

USE ONLY

LEGAL BUSINESS

NAME:

I I I I

TYPE OF LICENSE: (Check One)

WHOLESALE

RETAIL

MANUFACTURER

IMPORTER

I I I I I I I

WHEN DID OR WILL YOU START

SELLING TOBACCO

PRODUCTS?

KIND OF BUSINESS

ENGAGED

IF YOU ARE APPLYING

FOR A WHOLESALE

UCENSE,

COMPLETE

THE REMAINING

QUESTIONS

WHAT WERE YOUR GROSS SALES OF TAXABLE

CIGARS, CIGARETTES

AND LOOSE OR SMOKELESS

TOBACCO

FOR THE PAST YEAR?

DO YOU NOW OR DO YOU PLAN TO AFFIX

THE CIGARETTE

EXCISE STAMP?

DYES

DOES THE PERSON MAKING APPLICATION

HOLD A RETAIL CIGAR, CIGARETTE

OR LOOSE AND

SMOKELESS

TOBACCO

LICENSE?

DYES

(If "YES", list name of retail business and retail license number)

STI NUMBER

RETAIL BUSINESS

NAME

TOBACCO

LICENSE NUMBER

LIST ALL THE EMPLOYEES OF YOUR BUSINESS AND INDICATE THEIR POSITION AND SOCIAL SECURITY NUMBER

NAME

TITLE

SOCIAL

SECURITY

NO.

THIS APPLICATION

HAS BEEN EXAMINED

BY ME, AND TO THE BEST OF MY KNOWLEDGE

IS TRUE AND

CORRECT.

SIGNATURE

TITLE

DATE

(MUST

BE SIGNED

BY OWNER,

PARTNER,

OR AUTHROIZED

OFFICER

OF CORPORATION

- STAMPED

SIGNATURE

NOT ACCEPTABLE)

FOR OFFICE USE ONLY

TOTAL FEE PAID

REGISTRATION

STATUS

REGISTRATION

REASON

STATE LICENSE NUMBER

ISSUE DATE

Form Crf-008 - Tobacco License Application

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