Form Ct-124 - Cigarette Vending Machine Locations

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CT-124: CIGARETTE VENDING MACHINE LOCATIONS
Excise Tax Section 6-107
Wisconsin Department of Revenue
PO Box 8900
Madison, WI 53708-8900
(608) 261-6435
Legal Name
Federal Employer ID. No. or Social Security No.
TOTAL NO. OF MACHINES
List the location below where your vending machines are/will be located (attach sheet if additional space is needed).
Location’s
Location’s
Location
Business Address
No. of
Retail Cigarette License
Wis. Seller’s
Business/Trade Name
(street, city, state and zip code)
No. from Municipal Clerk
Permit No.
Machines
CT-124 (R. 12-11)

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