application for license to sell tobacco ......application for license to sell tobacco products north...

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APPLICATION FOR LICENSE TO SELL TOBACCO PRODUCTS NORTH DAKOTA OFFICE OF ATTORNEY GENERAL LICENSING SECTION SFN 61612 (02-2021) License Number License Year Please print or type legibly or it will delay processing. ALL APPLICANTS MUST COMPLETE Application is for New license License renewal License is for Retail location Wholesale/Distributor Applicant Name (if corp., LLC, etc., enter legal name) Business Name Mailing Address City State ZIP Code County Business Address City State ZIP Code County Business Telephone Number Other Contact Telephone Number Person to Contact Regarding Application Questions Name Telephone Number E-mail Address NEW APPLICANTS ONLY Description of business Intended beginning date to sell tobacco products Are you taking over this business from someone? Yes No If yes, enter the previous owner's name ALL APPLICANTS MUST COMPLETE Name of Individual Authorized to Sign on Behalf of Applicant (Print Name) Official Position Signature of Authorized Individual Date Tobacco licenses expire on June 30th of each year and must be renewed before expiration or a reinstatement fee will be required. LICENSE FEE: Retail $15.00 Wholesale/Distributor $25.00 PAYABLE TO: Attorney General For Licensing Use Only Mail to: Office of Attorney General Licensing Section 600 E Boulevard Ave Dept. 125 Bismarck ND 58505-0040 Questions please call (701) 328-2329 Wholesale/Distributor Federal EIN Cigars Cigarettes Chewing Tobacco Snuff Pipe Tobacco Other (Please Explain) Wholesale/Distributor types of tobacco products to be sold or imported

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Page 1: APPLICATION FOR LICENSE TO SELL TOBACCO ......APPLICATION FOR LICENSE TO SELL TOBACCO PRODUCTS NORTH DAKOTA OFFICE OF ATTORNEY GENERAL LICENSING SECTION SFN 61612 (02-2021) License

APPLICATION FOR LICENSE TO SELL TOBACCO PRODUCTS NORTH DAKOTA OFFICE OF ATTORNEY GENERAL LICENSING SECTION SFN 61612 (02-2021)

License Number

License Year

Please print or type legibly or it will delay processing. ALL APPLICANTS MUST COMPLETE Application is for

New license License renewalLicense is for

Retail location Wholesale/Distributor

Applicant Name (if corp., LLC, etc., enter legal name)

Business Name

Mailing Address City State ZIP Code County

Business Address City State ZIP Code County

Business Telephone Number Other Contact Telephone Number

Person to Contact Regarding Application QuestionsName Telephone Number E-mail Address

NEW APPLICANTS ONLYDescription of business Intended beginning date to sell tobacco products

Are you taking over this business from someone?Yes No

If yes, enter the previous owner's name

ALL APPLICANTS MUST COMPLETEName of Individual Authorized to Sign on Behalf of Applicant (Print Name) Official Position

Signature of Authorized Individual Date

Tobacco licenses expire on June 30th of each year and must be renewed before expiration or a reinstatement fee will be required.

LICENSE FEE: Retail $15.00 Wholesale/Distributor $25.00 PAYABLE TO: Attorney General

For Licensing Use Only

Mail to: Office of Attorney General Licensing Section 600 E Boulevard Ave Dept. 125 Bismarck ND 58505-0040

Questions please call (701) 328-2329

Wholesale/Distributor Federal EIN

Cigars Cigarettes Chewing Tobacco SnuffPipe Tobacco Other (Please Explain)

Wholesale/Distributor types of tobacco products to be sold or imported

atf_p_5310.2_wDO I NEED A LICENSE TO BUY AND SELL FIREARMS?eb

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