Form Ct-125 - Retail Cigarette Locations printable pdf download

Form Ct-125 - Retail Cigarette Locations

CT-125: RETAIL CIGARETTE LOCATIONS

(For Cigarette Multiple Retailer Applicants Only)

Do you own 10 or more retail locations, either in Wisconsin or outside Wisconsin, where you hold a valid cigarette retail license

and sell cigarettes to consumers?

Yes



If NO, stop here. You do not qualify for a cigarette multiple retailer permit.

2. Are all the locations under the same Federal Employer Identification Number (FEIN)?

Yes

If NO, stop here. You do not qualify for this permit.

Enter your FEIN

4. Indicate number of Wisconsin locations

and out-of-state locations

5. Identify below all cigarette retail locations operating under the FEIN entered above. List Wisconsin locations first. There is ad-

ditional space on back of form, if needed.

If you have questions regarding this form, contact us at (608) 261-6435 or excise@revenue.wi.gov. Return completed form to:

Excise Tax Section 6-107, Wisconsin Department of Revenue, PO Box 8900, Madison, WI 53708-8900.

The permit is issued to the headquarters’ location and covers only the qualified Wisconsin retail locations listed below.

Retail Cigarette License

Business Address

Wis. Seller’s

(street, city, state and zip code)

No. from Municipal Clerk

Business/Trade Name

Permit No.

CT-125 (R. 1-12)

Form Ct-125 - Retail Cigarette Locations