Form 637 - Cigarette And Tobacco Products (Otp) Licenses Application Page 3
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CIGARETTE AND OTHER TOBACCO
637
PRODUCTS (OTP) LICENSES APPLICATION
SECTION 5 – Cigarette and OTP Wholesalers - Complete this section in addition to Sections 1 and 7
A. 1. Do you have an established place of business, including warehouse facilities, for the sale of cigarettes? . . . .
YES
NO
2. Do you have an established place of business, including warehouse facilities, for the sale of OTP? . . . . . . . .
YES
NO
B. 1. Do you have the necessary equipment and vehicles for storage and distribution of cigarettes? . . . . . . . . . .
YES
NO
2. Do you have the necessary equipment and vehicles for storage and distribution of OTP? . . . . . . . . . . . . . .
YES
NO
C. If applying for a cigarette wholesale license, state type and brand of stamping equipment to be used with your
identification number(s). ___________________________________________________________________________________
_______________________________________________________________________________________________________
D. 1. Do the applicants have a financial interest in a cigarette manufacturer? . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
If yes, attach explanation.
2. Do the applicants have a financial interest in an OTP manufacturer? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
If yes, attach explanation.
SECTION 6 – Cigarette and Licensed OTP Manufacturer’s Complete this section in addition to Sections 1 and 7
A. 1. Do you operate one or more cigarette manufacturing plants within the United States? . . . . . . . . . . . . . . . .
YES
NO
2. Do you operate one or more OTP manufacturing plants in Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
B. 1. Do the applicants have a financial interest in a cigarette wholesaler? . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
If yes, attach explanation.
2. Do the applicants have a financial interest in an OTP wholesaler? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
If yes, attach explanation.
C. Do you intend to do any of the following in reference to cigarettes:
1. Sell unstamped cigarettes to a licensed cigarette wholesaler located in Maryland? . . . . . . . . . . . . . . . . . . .
YES
NO
2. Distribute sample cigarettes to consumers located in Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
3. Store unstamped cigarettes in a cigarette storage warehouse in Maryland for subsequent shipment to
licensed wholesalers, federal reservations, or persons out of state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
D. Do you intend to do any of the following in reference to OTP:
1. Sell OTP in Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
2. Sell “imported” OTP in Maryland? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
3. Store OTP in an OTP storage warehouse in Maryland for subsequent shipment to licensed wholesalers, . . .
federal reservations, or persons out of state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
YES
NO
SECTION 7 – All applicants must complete this section
Individual, Partner or a Corporate Officer listed on this form must sign.
NOTE: If there is a parent corporation, president or vice president of the parent corporation must also complete this section.
Affidavit
I do solemnly declare and affirm under the penalties of perjury that the contents of the foregoing document are true and correct
to the best of my knowledge, information and belief.
Signature of individual, partner or corporate officer
Title
Signature of parent corporate officer
Title
Type or print name of individual, partner or corporate
Date
Type or print parent corporate officer’s name who signed
Date
officer who signed above
above
Contact Information
COMPTROLLER OF MARYLAND
REVENUE ADMINISTRATION DIVISION
MOTOR-FUEL, ALCOHOL AND TOBACCO TAX UNIT
PO BOX 2999
ANNAPOLIS MD 21404-2999
410-260-7980
FAX 410-974-3201
COM/RAD-637
Revised 06/13
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