Form Ctp-129 - Application For Cigarette And Tobacco Products Permits/registration

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DEPARTMENT USE ONLY
CTP-129: APPLICATION FOR
Permit Number
CIGARETTE AND TOBACCO PRODUCTS
Period Covered
PERMITS/REGISTRATION
Date of Issuance
(Read instructions before completing this form)
Section 1: Applicant Information
Legal Name (corporation, limited liability company, partnership, or individual)
FEIN or SSN
(if sole proprietor or individual)
Business Name (DBA) (if different from Legal Name)
Business Telephone No.
City or Post Office
Business Address (Do not use PO Box)
State
Zip Code
City or Post Office
Mailing Address (if different from business address)
State
Zip Code
Business Located In:
City
Village
Town of:
, County of:
(municipal name)
(Wisconsin county name)
E-mail Address
Web Site Address
Section 2: Permit Type
Check the permit(s) for which you are applying and enclose one $20 Business Tax Registration fee (if applicable) regardless of the
number of permits you have checked.
Cigarette Multiple Retailer (complete Form CTP-125)
Cigarette Manufacturer (Attach copy of federal permit.)
Direct Marketer (check one)
Cigarette First Importer Record (Attach copy of federal permit.)
}
Cigarette Distributor
Bonded
Nonbonded
Will more than 50% of your cigarette sales
be at wholesale to retailers, vending ma-
Cigarette Jobber
Tobacco Products Manufacturer
(Enclose copy of federal
chine operators, or multiple retailers not
permit.)
owned, controlled, or operated by you?
Tobacco Products First Importer of Record
(Enclose copy of
Yes
No
federal permit.)
Cigarette Warehouse (WI only)
Tobacco Products Distributor
Cigarette Vending Machine Operator (complete Form CTP-124)
Tobacco Products Subjobber (WI only)
Section 3: Entity Type
(check one)
Sole Proprietor
Governmental Unit (check appropriate box below)
Partnership
Federal
County
Tribal
Local
Wisconsin Corporation (Date incorporated:
)
Wisconsin State
Limited Liability Company - Enter date registered with the
Out-of-State Corporation (Licensed in WI?
Yes
No
Department of Financial Institutions:
Other (describe)
For federal income tax purposes, will the LLC be taxed as a:
Partnership
Corporation
Single member LLC disregarded as a separate entity
ALL Applicants must complete and sign on page 3.
CTP-129 (R. 5-12)
Wisconsin Department of Revenue

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