Form 2175 - Missouri Cigarette/other Tobacco Products Tax License Application

Download a blank fillable Form 2175 - Missouri Cigarette/other Tobacco Products Tax License Application in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 2175 - Missouri Cigarette/other Tobacco Products Tax License Application with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Reset Form
Print Form
FOR OFFICE USE ONLY
MISSOURI DEPARTMENT OF REVENUE
FORM
TAXATION DIVISION
2175
LICENSE NUMBER
P.O. BOX 811, JEFFERSON CITY, MO 65105-0811
MISSOURI CIGARETTE/OTHER TOBACCO
(REV. 07-2011)
DATE ISSUED
CHECK NUMBER
PRODUCTS TAX LICENSE APPLICATION
$100.00 FEE IS REQUIRED WITH APPLICATION (MAKE CHECK PAYABLE TO “MISSOURI DEPARTMENT OF REVENUE”).
TYPE OF APPLICATION:
REGISTERING FOR:
NEW LICENSE
CIGARETTE WHOLESALER’S LICENSE
OTHER TOBACCO PRODUCTS LICENSE
BOTH
RENEWAL
DATE BUSINESS OPENED
Reset Section 1
SECTION 1 - BUSINESS NAME AND LOCATION
MO TAX I.D. NUMBER
FEDERAL I.D. NUMBER
____ ____ ____ ____ ____ ____ ____ ____
____ ____ ____ ____ ____ ____ ____ ____ _____
BUSINESS NAME
DBA NAME
PHYSICAL LOCATION
Cigarettes must be stamped and inventory maintained at the physical location. Cigarette tax stamps will be shipped to the physical location.
STREET
CITY, STATE, ZIP CODE
COUNTY
TELEPHONE NUMBER
FAX NUMBER
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
BUSINESS MAILING ADDRESS
STREET, ROUTE, OR P.O. BOX NUMBER
CITY, STATE, ZIP CODE
COUNTY
TELEPHONE NUMBER
FAX NUMBER
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
RECORD STORAGE ADDRESS (DO NOT USE P.O. BOX NUMBER)
STREET, HIGHWAY, ROUTE
CITY, STATE, ZIP CODE
COUNTY
TELEPHONE NUMBER
FAX NUMBER
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
SECTION 2 - TYPE OF OWNERSHIP
Reset Section 2
Please indicate your ownership type.
Sole Owner (may include spouse)
Other ____________________________________
Partnership
_____________________________________________
Limited Partnership – LP Number _____________________________________
_____________________________________________
Limited Liability Partnership – LLP Number _____________________________
Limited Liability Limited Partnership – LLLP Number _____________________________
Government
Not required to register with Missouri Secretary of
State
Trust
Date Incorporated:
___ ___ / ___ ___ / ___ ___
Missouri Corporation – Missouri Charter No. ___________________________________
State of Incorporation and Date Registered in
Non-Missouri Corporation – Certificate of Authority No. ___________________________
Missouri _______________________
Limited Liability Company:
__________________________________
Taxed as a Partnership
Taxed as a Sole Owner
Taxed as a Corporation LLC Number
Reset Section 3
SECTION 3 - CONTACT PERSONS
Missouri Statute 32.057, RSMo, states that all tax records and information maintained by the Missouri Department of Revenue are confidential. The tax
information can only be given to the owner, partner, member, or officer who is listed with us as such. If you wish to give an employee, attorney, or accountant
access to your tax information, you must supply us with a power of attorney giving us the authority to release confidential information to them.
CONTACT PERSON FOR REGISTRATION
TELEPHONE NUMBER
E-MAIL ADDRESS
POWER OF ATTORNEY
Yes*
No
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
CONTACT PERSON FOR REPORTING
TELEPHONE NUMBER
E-MAIL ADDRESS
POWER OF ATTORNEY
OTHER TOBACCO:
Yes*
No
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
CIGARETTE:
Yes*
No
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
MSA:
Yes*
No
( ___ ___ ___ ) ___ ___ ___ - ___ ___ ___ ___
* If Yes, attach a completed Form 2827 for Power of Attorney
1
DOR-2175 (07-2011)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 4