Form Ctx-Aw - Application For A Wholesale Cigarette License Or License To Operate Cigarette Vending Machines

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February 1, 20_ _ to January 31, 20_ _
The City of New York • Department of Finance
Fee: $600.00
Application for a Wholesale Cigarette License or
CTX-AW
F I N A N C E
NEW • YORK
License to Operate Cigarette Vending Machines
ENFORCEMENT
DIVISION
Name
FOR OFFICE USE ONLY
Trade name
New York City License Number
Place
of
Address
Location
Business
City and State
Zip Code
Date Issued
to be
Licensed
Telephone
Issued By
Federal Empl. Ident. No. or Social Security No.
New York State License Number
1.
Name of Operator if different from above
Trade Name
2.
Address of Headquarters Office
City and State
Zip Code
3.
Indicate Desired Type Wholesaler's License:
Agent-Jobber ❏
Sub-Jobber ❏
Vending Machine Operator ❏
4.
Indicate Nature of Ownership:
Individual ❏
Partnership ❏
Domestic Ass'n or Corp. ❏
Out-of-State Ass'n or Corp. ❏
Date Business began
Date of Incorporation
State
Date Authorized in New York City
5.
6.
If Business is being conducted under a Trade Name, give Date of Filing of Trade Name Certificate and Office of County Clerk in which filed
Date
County
If Successor to Licensed Wholesale, give Name and Address of Predecessor
7.
Name
Address
8.
Give Name, Titles and Residence Addresses of the Individual Proprietors, Partners, or Corporate Officers of your business
Name
Title
Home Address
Telephone
Name
Title
Home Address
Telephone
Name
Title
Home Address
Telephone
Name
Title
Home Address
Telephone
9.
Give Names and Addresses of Principal Firms from Whom you Purchase Cigarettes
Name
Business Address
Name
Business Address
Name
Business Address
10.
Do You Have a New York State Cigarette License?
Yes ❏
No ❏
If YES, indicate State Cigarette License Number
Are you a Registered Agent in New York State?
Yes ❏
No ❏
11.
If YES, indicate State Permit Number
FILL IN REVERSE SIDE

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