Form Ct102 - License Application To Make Retail Sales Of Cigarette And Other Tobacco Products

Download a blank fillable Form Ct102 - License Application To Make Retail Sales Of Cigarette And Other Tobacco Products in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Ct102 - License Application To Make Retail Sales Of Cigarette And Other Tobacco Products with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

CT102
License Application to Make Retail Sales of Cigarette and Other Tobacco Products
To be completed by applicant when applying for a license with a city or county.
FOR MUNICIPAL USE ONLY
Applicant’s Minnesota tax ID number
The Minnesota tax ID must be issued in the same
License number
legal name of the licensee below.
Period covered
Cigarettes/tobacco products will be sold (a separate license is required
for each location or vending machine):
Date of issuance
Over counter
Through vending machine
Both
Licensee’s legal name
Federal employer ID number (FEIN)
Business trade name (doing business as)
Daytime phone
Complete address of business location (permit location)
County
Other phone number
City
State
Zip code
Fax number
Mailing address (if different than business address)
City
State
Zip code
Email address
Type of legal organization (check one):
Sole proprietor
Minnesota corporation: Enter date of incorporation
Partnership
Out-of-state corporation: State of incorporation
Other (describe)
Are you registered to do business in Minnesota?
Yes
No
Corporate officers or partners (attach a list if necessary)
Name
Title
Address
City
State
Zip code
Name
Title
Address
City
State
Zip code
As a licensed tobacco products or cigarette retailer, I understand that:
1. I can purchase cigarettes only from a Minnesota distributor or subjobber who holds a license with the Minnesota Department of
Revenue.
2. I must obtain a tobacco products distributor license if I purchase untaxed tobacco products from an out-of-state company.
3. I may not sell cigarettes affixed with Minnesota Native American stamps unless my retail business is located on a reservation that
has a tax agreement with the State of Minnesota.
4. I may not purchase from or exchange cigarettes or tobacco products with another retailer.
5. I must keep complete and legible cigarette and tobacco products invoices on the licensed premises, or make invoices available
within one hour of request, for at least one year after the date of the purchase.
6. I know that the Minnesota Department of Revenue and/or law enforcement may conduct cigarette and tobacco inspections of
the premises, including inspections of inventory, invoices and licenses, and I understand that a refusal to allow an inspection is
grounds for revocation of my license.
7. I know that failure to comply with all requirements can result in criminal penalties, including the loss of cigarettes and tobacco
products.
Licensee signature
Title
Print name
Date
Daytime phone
Licensing agent’s signature
Title
Print name
Date
Daytime phone
License applicant: Submit this form to the licensing authority along with the license application.
Licensing authority: Mail or fax a copy of approved form to:
Minnesota Revenue, Mail Station 3331, St. Paul, MN 55146-3331.
(Rev. 8/12)

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go