Application For Cigarette Wholesale License, Cigarette Manufacturer License, Tobacco Retail License, And Other Tobacco Products Wholesale License Page 2

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List Names, Addresses, and Phone Numbers of People You Intend on Conducting Business With (If Needed Attach a List):
If Applicant is Filing for a Cigarette Wholesale Dealers License Please
Complete the Following Information:
If Applicant will Apply Nevada Indicia to Packages of Cigarettes
If Yes, Please Provide Stamp Machine Serial
Please Check Box
Number:
List Names, Addresses, and Phone Numbers of Current Suppliers (If Needed Attach a List):
List the Cigarette Brands You Intend to Sell (If Needed Attach a List):
Please Indicate the Date Your Cigarette Inventory Will Always Exceed $10,000.00 Wholesale Value:
If Applicant is Filing for a Cigarette Manufacturer Dealers License Please
Complete the Following Information:
List All Brand and Styles Applicant Will Be Selling Within The State of Nevada (If Needed Attach a List):
By Checking This Box You Certify You Are Compliant With the Master Settlement Agreement And Any And All
Regulations And/Or Laws That Are Specified Within This Section:
By Checking This Box You Certify Your brands you intend to sell in this State have been approved as Fire Standard Compliant
with the Nevada State Fire Marshalls Office:
BEFORE ANY MANUFACTURER CAN SELL CIGARETTES IN THE STATE OF NEVADA THEY MUST FIRST SUBMIT A LIST OF
CIGARETTES BY BRAND AND STYLE THEY INTEND TO SELL IN THIS STATE TO THE NEVADA DEPARTMENT OF ATTORNEY
GENERALS OFFICE AND THEY MUST ALSO CONTACT THE STATE OF NEVADA FIRE MARSHALLS OFFICE TO REGISTER SAID
BRANDS AS FIRE STANDARD COMPLIANT. IF YOU HAVE NOT SPOKEN TO THE CHIEF TOBACCO COUNSEL AT THE ATTORNEY
GENERALS OFFICE PLEASE CALL (775) 688-1818.
TO SPEAK TOTHE STATE OF NEVADA STATE FIRE MARSHALLS OFFICE PLEASE CALL: 775-684-7526
IF SAID APPLICANTS CIGARETTES OR ROLL YOUR OWN BRANDS ARE NOT LISTED ON THE NEVADA STATE TOBACCO
DIRECTORY THEY MAY NOT BE SOLD IN THIS STATE.
All Applicants Please List Three References With Whom You Have Done Business:
Name and Address
Name and Address
Name and Address
Please Print Name:
Please Sign Name:
Date:

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