Form Rc-2 - Cigarette Distributor License Application - Illinois Department Of Revenue
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4Illinois Department of Revenue
RC-2
Cigarette Distributor
License no. ___________________
License Application
Issued
__ __/__ __/__ __ __ __
Expires
__ __/__ __/__ __ __ __
Step 1: Check the act under which you are applying
Illinois Cigarette Tax Act
Illinois Cigarette Use Tax Act
Step 2: Identify your business
Business name __________________________________________
Cigarette license no. _____________________________________
(if you are currently licensed as an Illinois cigarette distributor)
Assumed name __________________________________________
IBT no.
__ __ __ __ - __ __ __ __
(if different from above)
Principal place of business _________________________________
FEIN
__ __ - __ __ __ __ __ __ __
Number and street (Do not write a post office box number.)
_______________________________________________________
City
State
ZIP
__________________________
(_____)____________________
County
Daytime telephone number
Step 3: Tell us about your business
(Use Page 4 for additional information, if needed.)
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Check your type of business ownership.
Do you hold any other permit or license from the State of
Illinois?
sole proprietor
partnership
corporation
yes
no
If “sole proprietor” or “partnership,” when was your business
formed under the name in Step 2?
If “yes,” write the type and number of each permit or license.
Date _ _/_ _/_ _ _ _
_______________________ __________________________
Type of permit or license
Permit or license number
If “corporation,” when and where was your business incorporated?
Date _ _/_ _/_ _ _ _
_______________________ __________________________
Type of permit or license
Permit or license number
State ______________________________________________
If “corporation,” you must also complete Step 4 on Page 2.
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How long have you been engaged in the sale of cigarette or
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What is your principal kind of business?
other tobacco products?
___________________________________________________
______ years
_______ months
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If your business is operating under an assumed name, have you
Check the source from which you intend to buy cigarettes?
filed that name with the county clerk or recorder?
direct from manufacturer
wholesaler outside Illinois
yes
no
Illinois wholesaler
other _________________
Write the name and address of each source.
4
Do you lease the premises in which your business is located?
Name ______________________________________________
yes
no
Address ____________________________________________
If “yes,” what is the name and address of the owner of the
___________________________________________________
premises and when does your lease expire?
Name _______________________________________________
Name ______________________________________________
Address _____________________________________________
Address ____________________________________________
____________________________________________________
___________________________________________________
Expiration date _ _/_ _/_ _ _ _
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Do you intend to sell cigarettes through vending machines?
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Does any public official have a direct or indirect interest in your
yes
no
business?
If “yes,” how many machines will you operate? ______________
yes
no
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If “yes,” who is the official and what office does he or she hold?
How many employees do you have engaged in the sale of
Name ______________________________________________
cigarette or other tobacco products?______________________
Office ______________________________________________
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Write the name and address of the person whom you have
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With whom do you do the business’ banking?
employed as the business’ manager or agent at the location
Bank name __________________________________________
listed in Step 2.
Other references ______________________________________
Name ______________________________________________
Address ____________________________________________
___________________________________________________
RC-2 (R-5/99)
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