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Form Ctx-Aw - Application For A Wholesale Cigarette License Or License To Operate Cigarette Vending Machines Page 4

NYC DEPARTMENT OF FINANCE SHERIFF DIVISION

REPORT OF CHANGES IN PERSONNEL, MOTOR

VEHICLES, AND LOCATION OF VENDING MACHINES

Department of Finance

NYC Department of Finance, Sheriff Division, CTX Unit, 30-10 Starr Avenue, 2nd Floor, Long Island City, NY 11101

Instructions: This form is used by all agent-jobbers, sub-jobbers and vending machine operators to report all changes in per-

sonnel (sales personnel, service personnel, etc.), motor vehicles, and locations of vending machines as required by the whole-

sale cigarette dealer’s license issued to you by the City of New York. Under DELETIONS, list information from schedules you

submitted previously that should be removed. Under ADDITIONS, list information that should be added to the most recently

submitted schedule.

Date:______________________

NYC License #:______________________________

Licensee Name:____________________________________________________________________________________________

Address:__________________________________________________________________________________________________

Number and Street

City:_______________________________________________________________ State:________ Zip Code:______________

DELETIONS

ADDITIONS

Name of Officer/Partner:__________________________________________ Title:____________________________

Signature:________________________________________________________________________________________

Visit Finance at nyc.gov/finance

CTX-A.34a 06.08.2017

Form Ctx-Aw - Application For A Wholesale Cigarette License Or License To Operate Cigarette Vending Machines Page 4