Oklahoma Business Registration Packet For Cigarette And Tobacco Licensing - Cigarette And Tobacco Supplement Page 4
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740002
Oklahoma Cigarette and Tobacco Licensing - Supplement
Business Name:
BTRG
AP
FEIN/SSN:
Store Location:
Current Sales Tax Permit Number:
Section 1
Check the License(s) for which You Are Applying:
1.
Cigarette Manufacturer License ......................................................................Complete Section 2.
2.
Joint Wholesalers Cigarette and Tobacco License .........................................Complete Section 3.
3.
Wholesale Cigarette License ..........................................................................Complete Section 3.
4.
Wholesale Cigarette Vehicle License
with Wholesale Cigarette License (See NOTE below)
.................................Complete Section 3.
5.
Wholesale Cigarette Vehicle License Only (See NOTE below)
......................Complete Section 3.
6.
Cigarette Distributing Agent License ...............................................................Complete Section 4.
7.
Retail Cigarette License ..................................................................................Complete Section 5.
8.
Wholesale Tobacco License ...........................................................................Complete Section 3.
9.
Wholesale Tobacco Vehicle License
with Wholesale Tobacco License (See NOTE below)
...................................Complete Section 3.
10.
Wholesale Tobacco
Vehicle License Only (See NOTE below)
.......................Complete Section 3.
11.
Tobacco Distributing Agent License ................................................................Complete Section 4.
12.
Retail Tobacco License ...................................................................................Complete Section 5.
NOTE: Attach a list of vehicles to include make, model, VIN and tag number. If the regular wholesale
license fee has been paid then each vehicle license is $10.00. If the regular wholesale license fee
has not been paid then the vehicle license is $250.00.
Section 2
Manufacturer:
Date of First Sales:
___________ / ___________ / __________
1. Do you owe $500.00 or more in delinquent cigarette taxes? ...................................
Yes
No
2. Have you had a cigarette manufacturer, wholesaler, retailer or distributor license
revoked by the Oklahoma Tax Commission in the past two years? .........................
Yes
No
3. Have you been convicted of a crime relating to stolen or counterfeit cigarettes, or
receiving stolen or counterfeit cigarettes, or have been convicted of or have
entered a plea of guilty or nolo contendere to any felony? .......................................
Yes
No
4. Applicant agrees to the jurisdiction of the Tax Commission and the courts of this
state for the purpose of enforcement of the provisions of Title 68, Sections 301
and/or 415 et seq. of this title; ..................................................................................
Yes
No
5. Applicant agrees to abide by the provisions of Title 68, Sections 301 and/or
415 et seq. of this title and the rules promulgated by the Tax Commission with
reference thereto; ......................................................................................................
Yes
No
A
(Section 2 continued on page B)
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