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SECTION A: GENERAL INSTRUCTIONS

Send this application, with Iowa form 70-031, proof of bond, and proper remittance to:

Mailing Address:

FED-EX Address:

Examination Section

Cigarette Tax

Iowa Department of Revenue

PO Box 10456

1305 E Walnut

Des Moines IA 50306-0456

Des Moines IA 50319

SECTION B: NEW 601/621 & 606/626 Cigarette & Tobacco Distributor ADDITIONAL REQUIREMENTS

New cigarette AND tobacco distributors must enclose letters from each manufacturer that intends to sell applicant unstamped cigarettes and

untaxed roll-your-own product. You must list all brands purchased from each manufacturer. Attach bond.

SECTION C:

ONLY APPROVED BRANDS OF CIGARETTES OR ROLL YOUR OWN PRODUCTS MAY BE SOLD IN IOWA – any brand not on the list

is contraband. The list of approved brands is always current at Any violation of

contraband or non-Iowa tax stamped package is subject to seizure and penalties under the provisions of the Iowa Code 453A & 453D.

All permit applicants must answer the following questions:

What type of products will you sell in Iowa? Check all that apply:

Cigarettes

Little Cigars

Roll Your Own

Pipe Tobacco

Large Cigars

Small/Filtered Cigars

Plug/Chewing Tobacco

Snuff

Blunts/Wraps

Hookah/Shisha

Other: List Type: _______________________________________________________

1. From whom will you purchase your cigarettes and roll-your-own product? List All: name, address, and type of products purchased from

each. Use separate sheet if necessary.

___________________________________________________________________________________________________________

2. To approximately how many retailers will you sell? _______________

3. How many of these retailers are directly affiliated with your organization? ______________

4. List names and addresses of your three biggest retailers.

a. _________________________________________________________________________________________________________

b. _________________________________________________________________________________________________________

c. _________________________________________________________________________________________________________

5. Do you sell directly to final consumers?

Yes

6. If yes, list names and addresses of your three biggest consumers:

a. _________________________________________________________________________________________________________

b. _________________________________________________________________________________________________________

c. _________________________________________________________________________________________________________

7. Do you maintain a warehouse for wholesale sales of cigarettes?

Yes

8. Will your wholesale cigarette number be printed on delivery vehicles?

Yes

SECTION D: 603 CIGARETTE VENDOR PERMIT ADDITIONAL REQUIREMENTS

Cigarette Vendor applicants must answer the following questions:

1. How many cigarette vending machines are in use?_______________

2. From whom do you purchase your cigarettes? __________________

3. Do you have your name and address on all of your vending machines?

Yes

4. Is the company name and permit number on all vehicles used for transporting cigarettes?

Yes

5. Is the location of each machine covered by a local retail permit?

Yes

6. List business name and location of each cigarette vending machine. Use separate sheet if necessary.

1. __________________________________________________________________________________________________________

2. __________________________________________________________________________________________________________

3. __________________________________________________________________________________________________________

4. __________________________________________________________________________________________________________

5. __________________________________________________________________________________________________________

If you have any questions pertaining to this application,

please call the Examination Section, Cigarette Tax Unit at 515-281-8023.

70-015b (06/09/10)

Form 70-015a - Annual Application For Iowa Cigarette Permit/tobacco Tax License - 2010 Page 4

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