Form Cig Tc00161 - Idaho Cigarette And Tobacco Tax Permit Application
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1C I G
T C 0 0 1 6 1
IDAHO CIGARETTE AND TOBACCO TAX PERMIT APPLICATION
1 2 - 1 6 - 9 4
For State Use Only
IDAHO STATE TAX COMMISSION
800 PARK BOULEVARD, PLAZA IV
P.O. BOX 36
BOISE, IDAHO 83722
( 2 0 8 ) 3 3 4 - 7 6 6 0
(800)972-7660 (ID, WA, OR & UT)
Instructions are on page 2.
1. Type of business
___Sole Proprietor
___Partnership
___Corporation
___S Corporation
___Limited Liability Company
2.
Business activity
___Cigarette Wholesaler
___Tobacco Distributor
___Cigarette
Manufacturer/Importer
3.
Purpose of application
___New business
___New location
___Change in "doing business as" name
___Change in partners or shareholders ___%
4. Federal EIN
5. Legal business name
6.
Social Security Number
7. Doing business as (DBA) name
C i t y
Zip Code
8.
Mailing address
Street address or P.O. Box
State
9.
Business Locations
C i t y
Street address
State
Mailing address
C i t y
State
Zip Code
10. Mailing Address
for Report Forms
11. Contact person
12.
Telephone number
13. Tax year end
14. Have you previously held an Idaho tobacco or cigarette permit?
Yes
No
If yes, what year?
Business name
Permit number
16. Date you began or will begin selling cigarettes in Idaho
15. Date you began or will begin selling tobacco in Idaho
17. Will you stamp cigarettes?
Yes
No
If yes, you must attach proof of your bond.
If no, from whom will you purchase stamped cigarettes?
18. List (a) owner, spouse, (b) partners or (c) corporate officers.
N a m e
Address
Social Security Number or EIN
IF YOU ARE APPLYING FOR A PERMIT AS A CIGARETTE WHOLESALER OR CIGARETTE MANUFACTURER/IMPORTER, YOU MUST ATTACH A
$50.00 PERMIT FEE
CERTIFICATION: I agree to comply with reporting, payment, record keeping, and license display requirements. I certify that I am authorized as an
owner, partner, corporate officer or representative to sign this document and that the statements made are correct to the best of my knowledge.
Date
Signature
Title
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Parent category: Financial