Form Ap-175 - Texas Application For Non-Retailer Cigarette, Cigar And/or Tobacco Products Permit Page 4
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4AP-175-4
(Rev.2-13/15)
Texas Application for Non-Retailer
Cigarette, Cigar and/or
• Type or print.
• Do NOT write in shaded areas.
Tobacco Products Permit
Page 3
29. Legal name of owner (same as Item 1)
•
f you purchased an existing business or business assets, complete Items 30-33; otherwise, skip to Item 34.
I
30. Enter the former owner's trade name. If known, enter the former owner's Texas taxpayer number.
Trade name
Taxpayer number of former owner
OF
NR
31. Enter the former owner's legal name. If known, enter the former owner's telephone number.
Legal name of former owner
Phone (area code and number)
Former owner is
Active
Address of former owner (street and number, city, state, ZIP code)
OOB
32. Check each of the following items you purchased. (This includes the value of stock exchanged for assets.)
Inventory
Corporate stock
Equipment
Real estate
Other assets
33. Enter the purchase price of the business or assets purchased and the date of purchase.
Purchase price
Date of purchase (month, day, year)
The sole owner, all general partners, corporation president, vice-president, secretary or treasurer, or an
Date of application (month, day, year)
authorized representative must sign this application. Representative must submit a written power of attorney
with application. (Attach additional sheets, if necessary.)
34. I (We) declare that the information in this document and any attachments is true and correct to the best of my (our) knowledge and belief.
Type or print name and title of sole owner, partner or officer
Sole owner, partner or officer
Type or print name and title of partner or officer
Partner or officer
Type or print name and title of partner or officer
Partner or officer
Your permit must be prominently displayed in your place of business.
All information provided on this form may be disclosed to the public, upon request, under the
Texas Public Information Act, Government Code, Chapter 552.
WARNING. You may be required to obtain an additional permit or license from the State of Texas or from a local governmental
entity to conduct business. A listing of links relating to acquiring licenses, permits, and registrations from the State of Texas is
available online at You may also want to contact the municipality and county in which you will conduct
business to determine any local governmental requirements.
Non-Retailer Permit Fees
(Cigarette and/or Tobacco Products Permits expire the last day of February each year.)
PERMIT TYPE
ANN. FEE
MAR.
APR.
MAY
JUNE
JULY
AUG.
SEPT.
OCT.
NOV.
DEC.*
JAN.*
FEB.*
Bonded agent
$300.00
$300.00
$275.00
$250.00
$225.00
$200.00
$175.00
$150.00
$125.00
$100.00
$75.00
$50.00
$25.00
Distributor
300.00
300.00
275.00
250.00
225.00
200.00
175.00
150.00
125.00
100.00
75.00
50.00
25.00
Manufacturer
300.00
300.00
275.00
250.00
225.00
200.00
175.00
150.00
125.00
100.00
75.00
50.00
25.00
Wholesaler
200.00
200.00
183.33
166.67
150.00
133.33
116.67
100.00
83.33
66.67
50.00
33.33
16.67
Vehicle
15.00
15.00
13.75
12.50
11.25
10.00
8.75
7.50
6.25
5.00
3.75
2.50
1.25
Importer
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
NO FEE
A vehicle permit can only be purchased in addition to a Distributor, Manufacturer or Wholesaler permit. The vehicle permit fees listed above reflect the amount due per vehicle.
* During the last three months of the permit period, the Comptroller may collect the prorated fee for the current period and the fee for the next period. Add the amount in the
"Annual Fee" column to the prorated amount for the applicable month. (i.e., January fee is $50.00 + annual fee of $300.00 = $350.00.)
A $50 late fee will be assessed on each existing location that is not in compliance with permit requirements. Tex. Tax Code Ann. Ch. 154 and/or Ch. 155.
Mail your completed application with the required permit fee to:
Make check payable to:
Comptroller of Public Accounts
State Comptroller
111 E. 17th St.
Austin, TX 78774-0100
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