Form 69-117 - Cigarette And Tobacco Products Retail Employee Notification
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269-117
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CLEAR FIELDS
(Rev.3-12/6)
Cigarette and Tobacco Products Retail Employee Notifi cation
Completed notifi cation forms must be kept at the retail location.
Retailer name
Location address
Street
City
State
ZIP code
Taxpayer number
Permit number
Outlet number
Notice and explanation given by:
Name
Title
Effective January 1, 1998, retailers are required to notify each employee engaged in the retail sale of cigarettes and/or tobacco prod-
ucts that state law:
(1) prohibits retailers and their employees from selling or providing tobacco products, or giving coupons for tobacco purchases
to any person under 18 years of age. A violation is a Class C misdemeanor;
(2) requires retail employees to request proof of age from anyone under 27 years of age who attempts to purchase cigarettes
or tobacco products. Retailers may be fi ned up to $1,000 per violation or have their permit revoked or suspended for selling
tobacco products to any person under 18 years of age;
(3) subjects retail employees to criminal prosecution for a Class C misdemeanor if they knowingly sell tobacco products
to minors;
(4) prohibits the sale of loose cigarettes or cigarettes in individual packages containing fewer than 20 cigarettes and imposes a
$100 fi ne for violations;
(5) prohibits the distribution of free samples of tobacco products to any person under 18 years of age;
(6) requires each person who sells cigarettes or tobacco products at retail or by vending machine to post a sign in a conspicuous
location warning employees and customers about the tobacco law and the penalties for violations of the law. The Comptroller,
on request, will provide the sign without charge to any person who sells cigarettes or tobacco products. Retail employees must
ensure that the appropriate sign is always properly displayed while they are on duty. A violation is a Class C misdemeanor.
(7) prohibits the sale of cigarettes or tobacco products in a manner that allows customers direct access to the cigarettes or
tobacco products. This provision does not apply to: a facility or business that is not open at any time to persons younger than
18 years of age; that part of a facility or business that is a humidor or other enclosure designed to store cigars in a climate-
controlled environment; or a package store properly permitted under the Alcoholic Beverage Code. A violation is a Class C
misdemeanor;
(8) prohibits the placement of tobacco vending machines in a manner permitting direct customer access in any business that
is accessible to minors. The Comptroller or a peace offi cer may, with or without a warrant, seize, seal, or disable a vending
machine installed or maintained in violation of this provision. A violation is a Class C misdemeanor.
Employee name
Social Security number
Current address
Street
City
State
ZIP code
Employment date
Termination date
I, _______________________________________________________ , have been notifi ed of the provisions of cigarette and
tobacco products law as required under Health & Safety Code, §161.085. By signing this form, I acknowledge that the law has
been fully explained to me and that I understand and agree to comply with the law as a condition of employment.
Employee Signature
Date
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