Signature Authorization For Cigarette Stamps - Nevada Department Of Taxation

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STATE OF NEVADA
DEPARTMENT OF TAXATION
RENO OFFICE
4600 Kietzke Lane
Web Site:
Building L, Suite 235
Reno, Nevada 89502
1550 College Parkway, Suite 115
Phone: (775) 687-9999
Carson City, Nevada 89706-7937
Fax: (775) 688-1303
Phone: (775) 684-2000
Fax: (775) 684-2020
BRIAN SANDOVAL
LAS VEGAS OFFICE
HENDERSON OFFICE
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Grant Sawyer Office Building, Suite1300
2550 Paseo Verde Parkway, Suite 180
ROBERT R. BARENGO
555 E. Washington Avenue
Henderson, Nevada 89074
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Las Vegas, Nevada 89101
Phone: (702) 486-2300
CHRISTOPHER G. NIELSON
Phone: (702) 486-2300
Fax: (702) 486-2373
Fax: (702) 486-3377
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SIGNATURE AUTHORIZATION FOR CIGARETTE STAMPS
Cigarette Wholesale Dealer:
Taxpayer ID # (TID#):_
Method of Shipment:
Shipper Account #:
The person(s) listed below are authorized to purchase and take receipt of Nevada cigarette tax stamps on behalf of
This Authorization is effective as of
and will continue in force until the last day of the current
licensed period or revoked/canceled by the Department of Taxation.
Signature and title of person authorized to act on behalf
Type or print
Of the above stated cigarette wholesale dealer
Name (Type or Print)
Signature
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

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