Form Or-318 - Cigarette Vending Machine Location Change printable pdf download

Form Or-318 - Cigarette Vending Machine Location Change

Department of Revenue Services

OR-318

State of Connecticut

PO Box 2937

Cigarette Vending Machine Location Change

Hartford CT 06104-2937

(Rev. 09/09)

Instructions

If you own and operate a cigarette vending machine or machines and have been issued either a cigarette dealer’s license or

cigarette distributor’s license by the Department of Revenue Services (DRS), you are required to report the following changes

to DRS by fax or mail no later than 30 days after the change:

 Change in location of an existing cigarette vending machine;

 Removal from service of an existing cigarette vending machine; or

 Placement of a new cigarette vending machine.

Fax:

860-297-4818

Mail: Walk-In Regisration Unit, Department of Revenue Services, State of Connecticut, PO Box 2937, Hartford CT 06104-2937.

If you have any questions, please contact the Registration Unit at 860-297-5770, Monday through Friday, 8:30 a.m. to 4:30 p.m.

Taxpayer Information

Name

CT Tax Registration Number

FEIN

Address

Date

Telephone number

Registered Machine(s) Moved to a New Location

(Attach additional sheet if necessary.)

Make of Machine

Model Number

Name and Address of Premises

Old location:

New location:

Old location:

New location:

Old location:

New location:

Old location:

New location:

Registered Machine(s) Removed From Service

(Attach additional sheet if necessary.)

Make of Machine

Model Number

Name and Address of Premises

Unregistered Machine(s) Brought into Service

(Attach additional sheet if necessary.)

Make of Machine

Model Number

Name and Address of Premises

Form Or-318 - Cigarette Vending Machine Location Change

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