Form Rc-2 - Cigarette Distributor License Application - Illinois Department Of Revenue Page 2
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4Step 4: Answer the following questions if your business is a corporation
If you are a sole proprietor or partnership, skip to Step 5.
(Use Page 4 for additional information, if needed.)
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6
What is your corporation’s Illinois address as stated in the
Is the corporation’s stock listed on any exchange or sold publicly?
certificate of incorporation?
yes
no
____________________________________________________
If “no,” write the name and address of all stockholders and the
Street address
percentage of stock each holds in the corporation.
IL
____________________________________________________
Name _______________________________________________
City
State
ZIP
Address _____________________________________________
2
What are the objects of corporation as set forth in your charter or
____________________________________________________
certificate of incorporation?
Percentage of stock ________%
____________________________________________________
Name _______________________________________________
3
Have your articles of incorporation been recorded with the county
Address _____________________________________________
clerk or recorder?
____________________________________________________
yes
no
Percentage of stock ________%
4
Are you a foreign corporation?
Name _______________________________________________
yes
no
Address _____________________________________________
If “yes,” when did you qualify to do business in Illinois and what is
____________________________________________________
the name and address of your resident agent in Illinois?
Percentage of stock ________%
Date _ _/_ _/_ _ _ _
Name _______________________________________________
Name _______________________________________________
Address _____________________________________________
Address _____________________________________________
____________________________________________________
____________________________________________________
Percentage of stock ________%
5
Is the majority interest of the corporation’s stock owned by one
person or his or her nominee?
Name _______________________________________________
yes
no
Address _____________________________________________
If “yes,” write the name of address of this person.
____________________________________________________
Name _______________________________________________
Percentage of stock ________%
Address _____________________________________________
____________________________________________________
If during the license period any person not named in Step 5 becomes
the record owner of more than 5 percent of the corporation’s stock,
you must send us the name, address, and percent of ownership of
such person within 10 days after the transfer.
Step 5: Tell us about your director, partners, officers, and yourself
(Use Page 4 for additional information, if needed.)
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__________________________
_____________________
__ __ __-__ __-__ __ __ __
__________________
_ _/_ _/_ _ _ _
Name (include middle initial)
Title
Social Security number
Place of birth
Date of birth
__________________________
___________________________________________________________________
______
_____
Street address of residence
City
State
ZIP
Race*
Sex
2
__________________________
_____________________
__ __ __-__ __-__ __ __ __
__________________
_ _/_ _/_ _ _ _
Name (include middle initial)
Title
Social Security number
Place of birth
Date of birth
__________________________
___________________________________________________________________
______
_____
Street address of residence
City
State
ZIP
Race*
Sex
3
__________________________
_____________________
__ __ __-__ __-__ __ __ __
__________________
_ _/_ _/_ _ _ _
Name (include middle initial)
Title
Social Security number
Place of birth
Date of birth
__________________________
___________________________________________________________________
______
_____
Street address of residence
City
State
ZIP
Race*
Sex
4
__________________________
_____________________
__ __ __-__ __-__ __ __ __
__________________
_ _/_ _/_ _ _ _
Name (include middle initial)
Title
Social Security number
Place of birth
Date of birth
__________________________
___________________________________________________________________
______
_____
Street address of residence
City
State
ZIP
Race*
Sex
5
__________________________
_____________________
__ __ __-__ __-__ __ __ __
__________________
_ _/_ _/_ _ _ _
Name (include middle initial)
Title
Social Security number
Place of birth
Date of birth
__________________________
___________________________________________________________________
______
_____
Street address of residence
City
State
ZIP
Race*
Sex
* A — Asian or Pacific Islander; B — Black; I — American Indian or Alaskan Native; W — White; O — Other
Page 2 of 4
RC-2 (R-5/99)
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