Form REG-1 Addendum A "Cigarette and Tobacco Products Taxes" - Connecticut

What Is Form REG-1 Addendum A?

This is a legal form that was released by the Connecticut Department of Revenue Services - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Connecticut Department of Revenue Services;
  • 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 Form REG-1 Addendum A by clicking the link below or browse more documents and templates provided by the Connecticut Department of Revenue Services.

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Download Form REG-1 Addendum A "Cigarette and Tobacco Products Taxes" - Connecticut

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Department of Revenue Services
REG-1 Addendum A
State of Connecticut
Cigarette and Tobacco Products Taxes
Rev. (06/18)
Entity name
Registration Confirmation # or CT Tax Registration #
Instructions
1. This addendum must be submitted with Form REG-1, Business Taxes Registration Application, if you are registering for any of the taxes listed below.
If you are filing this addendum as an over-the-counter cigarette dealer (retailer), you can complete Form REG-1 and this
addendum online through the TSC. All other applicants must file this addendum in person at any of our regional offices or mail it to:
Department of Revenue Services, PO Box 2937, Hartford, CT 06104-2937.
2. If you have been issued a Registration Confirmation Number or a Connecticut Tax Registration Number by the Department of Revenue
Services (DRS), enter the number in the space provided above and complete Form REG-1, Sections 1 through 6 and Section 14.
3. If you are applying for a cigarette distributor license and will be purchasing cigarettes to which Connecticut cigarette tax stamps are not
affixed, you will be required to provide additional information. Contact DRS at 860-297-5770 during business hours.
4. If you will sell both taxed and untaxed tobacco products, you need only apply for the tobacco products distributor license.
5. See Fee Information, on Page 3. This application will not be processed without the correct accompanying fees.
Read the definitions below and check the box(es) next to the license you are applying for.
Part I: Cigarettes (Cigarette licenses expire September 30 of each year.)
Dealer
Over-the-counter retailer: Any person selling cigarettes or taxed tobacco products at a retail store.
Tobacco products mean cigars; cheroots; stogies; periques; granulated, plug cut, crimp cut, ready rubbed, and other smoking tobacco; snuff tobacco products;
cavendish, plug, and twist tobacco; fine cut and other chewing tobaccos; shorts, refuse scraps, clippings, cuttings, and sweepings of tobacco; and all other kinds
and forms of tobacco prepared in a manner as to be suitable for chewing or smoking in a pipe or otherwise or for both chewing and smoking. Tobacco products
do not include cigarettes.
Taxed tobacco products mean tobacco products purchased from persons licensed by DRS as tobacco products distributors. A list of persons licensed by DRS
as tobacco products distributors is posted on the DRS website. These are tobacco products on which the Connecticut tobacco products tax has been paid.
Vending machine dealer: Any person operating and servicing 24 or less cigarette vending machines.
If you check the box for vending machine dealer, enter the number of vending machines you will
Number of
own and operate. Exclude any vending machines in storage. Complete Schedule A, on Page 2.
machines:
Distributor
Do you intend to purchase cigarettes to which you will affix Connecticut cigarette tax stamps? ..................
Yes
No
Address where stamps will be affixed or cigarettes stored:
___________________________________________________________________________________________
You are required to attach an affidavit from each of three recognized manufacturers of cigarettes stating the manufacturer’s intent to supply cigarettes to you
if you are licensed by DRS as a cigarette distributor, except as otherwise noted. The manufacturers listed in the Connecticut Tobacco Directory constitute the
recognized manufacturers of cigarettes. If you are purchasing the business of a person licensed by DRS as a cigarette distributor, or if
you are applying as a chain store operator, you are not required to attach the affidavits.
Wholesaler: Any person, other than a buying pool, who purchases cigarettes at wholesale from manufacturers or other distributors
for sale to licensed dealers, and who maintains an established place of business which has facilities in which a substantial stock of
cigarettes and related merchandise for resale can be kept at all times, and who sells at least 75% of the cigarettes to retailers who at
no time will own any interest in the business of the distributor as a partner, stockholder, or trustee.
Chain store distributor: Any person operating five or more retail stores in Connecticut for the sale of cigarettes (chain store
operator) or any person franchising five or more retail stores in Connecticut for the sale of cigarettes (chain store franchisor) must
complete Schedule B, on Page 2, or attach a list showing the name, physical location, and Connecticut Tax Registration Number
of each retail store in Connecticut operated or franchised by the chain store distributor at which cigarettes are sold at retail. A chain
store operator must be the person issued the sales tax permit and the cigarette dealer’s license for each location listed by the chain
store operator. A chain store franchisor will not be the person issued the sales tax permit and the cigarette dealer’s license for each
location listed by the chain store franchisor. Upon specific request by DRS, a chain store franchisor shall provide the franchise
agreement with each franchisee.
Vending machine operator: Any person operating and servicing 25 or more cigarette vending machines in this state who buys the
cigarettes at wholesale and sells them in vending machines.
If you check the box for vending machine operator, enter the number of vending machines you will
Number of
own and operate. Exclude any vending machines in storage. Complete Schedule A, on Page 2.
machines:
Importer: Any person who imports into this state unstamped cigarettes, at least 75% of which are to be sold to others for resale.
Storage facility operator: Any person operating storage facilities for unstamped cigarettes in this state.
Manufacturer
Manufacturer: Any person in Connecticut engaged in the business of manufacturing cigarettes or any person who is a tobacco
products manufacturer as defined in Conn. Gen. Stat. §4-28h(11).
All Applicants
/
/
If you check any of the boxes in Part I, enter the date that you will start selling cigarettes: ................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Department of Revenue Services
REG-1 Addendum A
State of Connecticut
Cigarette and Tobacco Products Taxes
Rev. (06/18)
Entity name
Registration Confirmation # or CT Tax Registration #
Instructions
1. This addendum must be submitted with Form REG-1, Business Taxes Registration Application, if you are registering for any of the taxes listed below.
If you are filing this addendum as an over-the-counter cigarette dealer (retailer), you can complete Form REG-1 and this
addendum online through the TSC. All other applicants must file this addendum in person at any of our regional offices or mail it to:
Department of Revenue Services, PO Box 2937, Hartford, CT 06104-2937.
2. If you have been issued a Registration Confirmation Number or a Connecticut Tax Registration Number by the Department of Revenue
Services (DRS), enter the number in the space provided above and complete Form REG-1, Sections 1 through 6 and Section 14.
3. If you are applying for a cigarette distributor license and will be purchasing cigarettes to which Connecticut cigarette tax stamps are not
affixed, you will be required to provide additional information. Contact DRS at 860-297-5770 during business hours.
4. If you will sell both taxed and untaxed tobacco products, you need only apply for the tobacco products distributor license.
5. See Fee Information, on Page 3. This application will not be processed without the correct accompanying fees.
Read the definitions below and check the box(es) next to the license you are applying for.
Part I: Cigarettes (Cigarette licenses expire September 30 of each year.)
Dealer
Over-the-counter retailer: Any person selling cigarettes or taxed tobacco products at a retail store.
Tobacco products mean cigars; cheroots; stogies; periques; granulated, plug cut, crimp cut, ready rubbed, and other smoking tobacco; snuff tobacco products;
cavendish, plug, and twist tobacco; fine cut and other chewing tobaccos; shorts, refuse scraps, clippings, cuttings, and sweepings of tobacco; and all other kinds
and forms of tobacco prepared in a manner as to be suitable for chewing or smoking in a pipe or otherwise or for both chewing and smoking. Tobacco products
do not include cigarettes.
Taxed tobacco products mean tobacco products purchased from persons licensed by DRS as tobacco products distributors. A list of persons licensed by DRS
as tobacco products distributors is posted on the DRS website. These are tobacco products on which the Connecticut tobacco products tax has been paid.
Vending machine dealer: Any person operating and servicing 24 or less cigarette vending machines.
If you check the box for vending machine dealer, enter the number of vending machines you will
Number of
own and operate. Exclude any vending machines in storage. Complete Schedule A, on Page 2.
machines:
Distributor
Do you intend to purchase cigarettes to which you will affix Connecticut cigarette tax stamps? ..................
Yes
No
Address where stamps will be affixed or cigarettes stored:
___________________________________________________________________________________________
You are required to attach an affidavit from each of three recognized manufacturers of cigarettes stating the manufacturer’s intent to supply cigarettes to you
if you are licensed by DRS as a cigarette distributor, except as otherwise noted. The manufacturers listed in the Connecticut Tobacco Directory constitute the
recognized manufacturers of cigarettes. If you are purchasing the business of a person licensed by DRS as a cigarette distributor, or if
you are applying as a chain store operator, you are not required to attach the affidavits.
Wholesaler: Any person, other than a buying pool, who purchases cigarettes at wholesale from manufacturers or other distributors
for sale to licensed dealers, and who maintains an established place of business which has facilities in which a substantial stock of
cigarettes and related merchandise for resale can be kept at all times, and who sells at least 75% of the cigarettes to retailers who at
no time will own any interest in the business of the distributor as a partner, stockholder, or trustee.
Chain store distributor: Any person operating five or more retail stores in Connecticut for the sale of cigarettes (chain store
operator) or any person franchising five or more retail stores in Connecticut for the sale of cigarettes (chain store franchisor) must
complete Schedule B, on Page 2, or attach a list showing the name, physical location, and Connecticut Tax Registration Number
of each retail store in Connecticut operated or franchised by the chain store distributor at which cigarettes are sold at retail. A chain
store operator must be the person issued the sales tax permit and the cigarette dealer’s license for each location listed by the chain
store operator. A chain store franchisor will not be the person issued the sales tax permit and the cigarette dealer’s license for each
location listed by the chain store franchisor. Upon specific request by DRS, a chain store franchisor shall provide the franchise
agreement with each franchisee.
Vending machine operator: Any person operating and servicing 25 or more cigarette vending machines in this state who buys the
cigarettes at wholesale and sells them in vending machines.
If you check the box for vending machine operator, enter the number of vending machines you will
Number of
own and operate. Exclude any vending machines in storage. Complete Schedule A, on Page 2.
machines:
Importer: Any person who imports into this state unstamped cigarettes, at least 75% of which are to be sold to others for resale.
Storage facility operator: Any person operating storage facilities for unstamped cigarettes in this state.
Manufacturer
Manufacturer: Any person in Connecticut engaged in the business of manufacturing cigarettes or any person who is a tobacco
products manufacturer as defined in Conn. Gen. Stat. §4-28h(11).
All Applicants
/
/
If you check any of the boxes in Part I, enter the date that you will start selling cigarettes: ................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Part II: Tobacco products other than cigarettes (Tobacco products licenses expire June 30 of each year).
Tobacco products distributor:
1. Any person in Connecticut engaged in the business of manufacturing tobacco products;
2. Any person purchasing untaxed tobacco products at wholesale from manufacturers or other distributors for sale; or
3. Any person importing into this state untaxed tobacco products, at least 75% of which are to be sold.
Untaxed tobacco products mean tobacco products (as defined in Part I) purchased from persons not licensed by DRS as tobacco products distributors. These
are tobacco products on which the Connecticut tobacco products tax has not been paid.
Unclassified importer: Any person, other than a tobacco products distributor, who imports, receives, or acquires untaxed tobacco
products from outside this state for his or her personal use or consumption in this state.
If you check any of the boxes in Part II, enter the date that you will start manufacturing or purchasing
/
/
untaxed tobacco products
............................................................................................................................................
__ __
__ __
__ __ __ __
m m
d d
y y y y
Schedule A: Description and Location of Vending Machines Attach list if necessary.
Make of Machine
Model Number
Name and Complete Address of the Premises Where Machines Are Located
Schedule B: Retail Store Locations of Chain Store Distributors Attach list if necessary.
Tax Registration Number
Name and Complete Physical Address of Retail Store
REG-1 Addendum A Rev.(06/18)
Page 2 of 3
Declaration for Cigarette Distributors Who Will Not Purchase Unstamped Cigarettes: In accordance with the provisions of Conn. Agencies
Regs. §12-293a(a)-1, the undersigned applicant for a cigarette distributor’s license requests permission from DRS to be exempted from filing
Form CT-15, Monthly Tax Stamp and Cigarette Report, Resident Distributor, or Form CT-15a, Monthly Tax Stamp and Cigarette Report, Nonresident
Distributor, for a period corresponding with the license.
I attest: (a) I will not acquire unstamped cigarettes or cigarettes bearing tax stamps of other states in the conduct of my business; and (b) should
I desire to acquire unstamped cigarettes or cigarettes bearing tax stamps of other states during the period this declaration is in effect, I know that
I must immediately notify the Commissioner of Revenue Services and that any privileges granted to me by this declaration will become null and
void and I will be required to file monthly distributor’s reports.
Authorized signature
Title
Date
Declaration for All Taxpayers: I declare under penalty of law that I have examined this application (including any accompanying schedules and
statements) and, to the best of my knowledge and belief, it is true, complete, and correct. I agree to comply and I attest that I have complied with,
the provisions of Chapter 214 of the Connecticut General Statutes, including the prohibition against selling cigarettes below cost, placement of
vending machines where accessible to minors, and with all rules and regulations made under Chapter 214, and have complied with all laws of
the State of Connecticut related to cigarette taxes. I understand the penalty for willfully delivering a false application to DRS is a fine of not more
than $5,000, or imprisonment for not more than five years, or both.
Authorized signature
Title
Date
Fee Information
(License fees are not prorated.)
Fee
Remitted
$50.00
Cigarette Dealer’s License - retailer of cigarettes or taxed tobacco products
$
$50.00
Cigarette Dealer’s License - vending machine dealer (1 to 24 vending machines)
$
$1,250.00
Cigarette Distributor’s License - vending machine operator (25 or more vending machines)
$
$1,250.00
Cigarette Distributor’s License - wholesaler, importer, storage facility operator
$
$315.00
5 to 14 retail locations under same ownership or franchise
$
Cigarette
Distributor’s License -
$625.00
15 to 24 retail locations under same ownership or franchise
$
chain store
distributor
$1,250.00
25 or more retail locations under same ownership or franchise
$
$5 per day
Penalty for failure to secure cigarette license
$5 per day X
days
$
________________
$5,250.00
Cigarette Manufacturer’s License
$
$200.00
Tobacco Products Distributor’s License
$
$0.00
Tobacco Products Unclassified Importer’s License
$
Total Remitted (Enter total amount due here and on Form REG-1, Section 13, Line b.)
$
REG-1 Addendum A (Rev. 06/18)
Page 3 of 3
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