Application For Cigarette Wholesale License, Cigarette Manufacturer License, Tobacco Retail License, And Other Tobacco Products Wholesale License

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Department of Taxation
Web Site:
1550 College Parkway, Suite 115
Carson City, Nevada 89706-7937
Phone (775) 684-2000 Fax (775) 684-2020
Application for Cigarette Wholesale License, Cigarette
Manufacturer License, Tobacco Retail License, and Other Tobacco
Products Wholesale License
Cigarette Wholesale License Fee is $150.00 annually (NRS 370.150) or prorated by quarter as follows:
Jan-Mar $150.00, Apr-June $112.50, July-Sept $75.00, Oct-Dec $37.50
A minimum $1000.00 security bond is required for all Cigarette Wholesale Dealers (NRS 370.155)
Please Check
All That Apply:
Wholesale Cigarette
Manufacturer Cigarette
Other Tobacco Products Wholesale
Tobacco Retail
Date You Intend To Start Selling Tobacco Products:
Federal Identification Number:
Type Of Business (Owner, Partnership, Corporation, Other):
Date Incorporated:
Corporation Name:
Doing Business As:
Operating Under a Fictitious Firm Name?
Is Statement Recorded?
Where?
If operating under a fictitious firm name within the state of Nevada please attach a certified copy of the fictitious
firm name certificate
Does Applicant Hold a State, County, Or City License?
If Yes Where?
Corporate Address:
Location Mailing Address:
Location Physical Location:
Business Telephone Number: (
)
Business Fax Number: (
)
Owner/Partner Names (or) Corporate Officers:
List All Owners, Partners, Corporate Officers, Managers, Members, etc. (If individual ownership, list only one owner.) Attach Additional Sheets if
Needed.
Name:
Title:
SSN#:
Residence Address:
City,
Percent
State, Zip.
Owned:
Name:
Title:
SSN#:
Residence Address:
City,
Percent
State, Zip.
Owned:
Name:
Title:
SSN#
Residence Address:
City,
Percent
State, Zip.
Owned:
Name:
Title:
SSN#:
Residence Address:
City,
Percent
State, Zip.
Owned:
Person to Contact Regarding Monthly Returns:
Title:
Contact Telephone Number:
(
)
Ext:
Contact Fax Number:
(
)
Please Provide One E-mail Address For The Person Who Will Receive Notifications Of Changes To The State of Nevada
Tobacco Directory:
Please List Other States in Which Applicant Holds A Retail or Wholesale Cigarette License:
(If Applicable Please Attach Copies Of Said Licenses)
Has Applicant or Person(s) Directly or Indirectly Owning 10 Percent or More of Said Business Been Convicted of a Crime
Relating to Tobacco?
If So Please Explain in Detail or Attach Additional Information Regarding the Charge:

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