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

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NYC DEPARTMENT OF FINANCE
ENFORCEMENT DIVISION
REPORT OF CHANGES IN PERSONNEL, MOTOR
G
TM
VEHICLES, AND LOCATION OF VENDING MACHINES
Finance
NYC Department of Finance, Enforcement 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 dealerʼs 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 07.11.11

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