Form Rc-2 - Cigarette Distributor License Application - Illinois Department Of Revenue Page 4

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Additional information
This form is authorized by the Cigarette Tax and Cigarette Use Tax acts. Disclosure of this information is REQUIRED. Failure to comply
RC-2 (R-5/99)
Page 4 of 4
may result in this form not being processed. This form has been approved by the Forms Management Center.
IL-492-0004

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