VT Form CTT-647 "Vermont Wholesale Cigarette and Tobacco Dealer License Application" - Vermont

What Is VT Form CTT-647?

This is a legal form that was released by the Vermont Department of Taxes - a government authority operating within Vermont. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Vermont Department of Taxes;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of VT Form CTT-647 by clicking the link below or browse more documents and templates provided by the Vermont Department of Taxes.

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Download VT Form CTT-647 "Vermont Wholesale Cigarette and Tobacco Dealer License Application" - Vermont

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Vermont Department of Taxes
133 State Street
Montpelier, VT 05633-1401
Phone: (802) 828-2551
VERMONT WHOLESALE CIGARETTE
VT Form
AND TOBACCO DEALER
CTT-647
LICENSE APPLICATION
TYPE or PRINT - Incomplete and/or illegible applications will be returned.
Business Information
Business/Entity Type (check ONE)
Sole Proprietor (Individual, Married, or Civil Union)
Partnership
S-Corporation
C-Corporation
Single Member LLC
LLC
Other
Owner (Name of Corporation, LLC, or Partnership)
FEIN
OR
Individual Last Name (Sole Proprietor only)
First Name
MI
Social Security Number
Spouse/CU Partner Last Name (Sole Proprietor only)
First Name
MI
Spouse/CU Partner Social Security Number
Trade Name or d/b/a
Primary Contact Name (Last, First, Middle)
Business Mailing Address
Telephone Number
City
State
ZIP Code
Fax Number
E-mail Address
Business Activity (check all that apply)
Manufacturer
Business Physical Address
Retailer
City
State
ZIP Code
Dealer
Principal Owners
- List if the applicant is a corporation, partnership, or LLC (ownership of 10% or more).
PRINCIPAL OWNER #1
For Department Use Only
Last Name
First Name
MI
Address
City
State
ZIP Code
PRINCIPAL OWNER #2
For Department Use Only
Last Name
First Name
MI
Address
City
State
ZIP Code
PRINCIPAL OWNER #3
For Department Use Only
Last Name
First Name
MI
Address
City
State
ZIP Code
(continued on next page)
Form CTT-647
Page 1 of 2
Rev. 06/19
Vermont Department of Taxes
133 State Street
Montpelier, VT 05633-1401
Phone: (802) 828-2551
VERMONT WHOLESALE CIGARETTE
VT Form
AND TOBACCO DEALER
CTT-647
LICENSE APPLICATION
TYPE or PRINT - Incomplete and/or illegible applications will be returned.
Business Information
Business/Entity Type (check ONE)
Sole Proprietor (Individual, Married, or Civil Union)
Partnership
S-Corporation
C-Corporation
Single Member LLC
LLC
Other
Owner (Name of Corporation, LLC, or Partnership)
FEIN
OR
Individual Last Name (Sole Proprietor only)
First Name
MI
Social Security Number
Spouse/CU Partner Last Name (Sole Proprietor only)
First Name
MI
Spouse/CU Partner Social Security Number
Trade Name or d/b/a
Primary Contact Name (Last, First, Middle)
Business Mailing Address
Telephone Number
City
State
ZIP Code
Fax Number
E-mail Address
Business Activity (check all that apply)
Manufacturer
Business Physical Address
Retailer
City
State
ZIP Code
Dealer
Principal Owners
- List if the applicant is a corporation, partnership, or LLC (ownership of 10% or more).
PRINCIPAL OWNER #1
For Department Use Only
Last Name
First Name
MI
Address
City
State
ZIP Code
PRINCIPAL OWNER #2
For Department Use Only
Last Name
First Name
MI
Address
City
State
ZIP Code
PRINCIPAL OWNER #3
For Department Use Only
Last Name
First Name
MI
Address
City
State
ZIP Code
(continued on next page)
Form CTT-647
Page 1 of 2
Rev. 06/19
Entity name
FEIN
Questions
1.
Has your business previously applied for a Vermont Wholesale Cigarette and Tobacco
Dealer License? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
2.
Do you have multiple locations with Cigarette and Tobacco inventory? . . . . . . . . . . . . . . . . . . . .  Yes
 No
3.
Do you sell unstamped cigarettes or small cigars to businesses or customers outside of
Vermont? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
3a. If you answered “Yes” to Question #3, which state(s): _____________________________________________
4.
List addresses of all warehouses or storage facilities where Vermont stamped cigarettes handled by you are stored.
Address
City
State
ZIP Code
Address
City
State
ZIP Code
Address
City
State
ZIP Code
Address
City
State
ZIP Code
5.
Will you be sending samples of unstamped cigarettes or small cigars to licensed
Vermont Dealers? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
6.
Will you be affixing tax stamps to packages of cigarettes purchased for sale to retailers? . . . . . .  Yes
 No
7.
Will you be purchasing for sale any of the following products from out-of-state unlicensed suppliers:
7a. Cigars, cigarillos, chewing tobacco, pipe tobacco, blunts and wraps, new smokeless
tobacco, snus, orbs, “dry” snuff in pouches, or smokeless hard tobacco? . . . . . . . . . . . . . . .  Yes
 No
7b. Snuff? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
7c. Roll-your-own tobacco? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
7d. Little cigars? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
7e. Electronic cigarettes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Yes
 No
7f. Other? ______________________________________________________ . . . . . . . . . . . .  Yes
 No
If the products you are selling change, it is your responsibility to notify the Vermont Department of Taxes in writing.
Signature
I hereby certify that I have examined this return, and to the best of my knowledge and belief, it is true, correct, and complete.
Signature
Date
Printed Name
Title
Telephone Number
Form CTT-647
Page 2 of 2
Rev. 06/19
Page of 2