Form Ap-193 - Texas Application For Retailer Cigarette, Cigar And/or Tobacco Products Taxes Permit Page 3

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AP-193-3

PRINT FORM

CLEAR FORM

Texas Application for

(Rev.8-11/13)

Retailer Cigarette, Cigar and/or

Tobacco Products Taxes Permit

• Type or print.

Page 1

You MUST have an active Sales and Use Tax Permit for the business location on this application (Item 6). If you do not have an

active Sales and Use Tax Permit, you must also complete the AP-201, Texas Application for Sales Tax Permit, Use Tax Permit

and/or Telecommunications Infrastructure Fund Assessments, or you can apply online at

1. Enter your 11-digit taxpayer number for reporting

Texas Sales and Use Tax or any other Texas taxes or fees .............................................................

2. Legal name of entity (sole owner or partners; first name, middle initial and last name; corporation or other name)

3. Mailing address for cigarette and/or tobacco related information

(street and number, P.O. Box or rural route and box number)

City

State

ZIP code

County

4. Enter the name and daytime telephone number(s) of the person primarily responsible for this business.

Name

Telephone (area code and number)

Mobile (area code and number)

FAX (area code and number)

NOTE: The commercial business location must have regular, posted business hours and cannot be a residence, a postal box of any type

or a unit in a public storage facility.

5. Commercial business location name

6. Commercial business location address

(Use street address, city, state and ZIP code – Do NOT use P.O. Box or rural route and box number.)

County name

7. Enter the name and telephone number(s) of the person primarily responsible for this commercial business location.

Name

Telephone (area code and number)

Mobile (area code and number)

FAX (area code and number)

8. Is this a commercial business location? ......................................................................................................................................

YES

9. Is this commercial business location inside the city limits? .........................................................................................................

YES

10. Will you keep the cigarettes, cigars and/or tobacco products books and records at this location? ............................................

YES

11. Will you be selling or storing cigarettes, cigars and/or tobacco products from this location? .....................................................

YES

12. Does this commercial business location include a humidor? ......................................................................................................

YES

A humidor is a storage area for cigars equipped with a humidifying device that has a high concentration of water vapor or moisture.

month

day

year

13. What is the date that you are planning to start selling cigarettes, cigars

and/or tobacco products from this commercial business location? ........................................................................

NOTE: State law requires all Internet, mail order and telephone cigarette sellers planning to deliver cigarettes to a purchaser in Texas to

register their business with the state and collect all applicable state taxes and remit them to the Comptroller's office.

14. Are you planning to sell cigarettes over the Internet, by mail order or by telephone? .................................................................

YES

15. If you answered "YES," in Item 14 above, please provide your email or Web page address.

month

day

year

16. What date are you planning to start selling cigarettes over the Internet, by telephone or by mail order? ..............