Form TOB: APP-R "Application for Tobacco Stamping Permit" - Alabama

What Is Form TOB: APP-R?

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

Form Details:

  • Released on May 1, 2014;
  • The latest edition provided by the Alabama Department of Revenue;
  • 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 fillable version of Form TOB: APP-R by clicking the link below or browse more documents and templates provided by the Alabama Department of Revenue.

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Download Form TOB: APP-R "Application for Tobacco Stamping Permit" - Alabama

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TOB: APP-R
5/14
A
D
R
LABAMA
EPARTMENT OF
EVENUE
B
& L
T
D
USINESS
ICENSE
Ax
IVISION
Reset
T
T
S
OBACCO
Ax
ECTION
P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627
www.revenue.alabama.gov
Application For Tobacco Stamping Permit
(RESIDENT WHOLESALER)
TO THE ALABAMA DEPARTMENT OF REVENUE:
1. We, _________________________________________________________________________________________, whose place of business is located at
COMPANY NAME
____________________________________________________________________________________________________________________________, in
STREET ADDRESS
_________________________________________________, Alabama __________________ do hereby apply for a wholesaler’s or jobber’s permit as
CITY
ZIP
required by Code of Alabama 1975, Section 40-25-16. If permit is issued, we agree not to pass on any part of the seven and one-half percent
discount allowed by the State on the purchase of stamps. We also furnish the following information:
2. FEIN:
OR SSN:
Telephone Number:
/
3. Contact Person: ______________________________________________________ Title: __________________________________________________
E-Mail Address: ______________________________________________________________________________________________________________
4. Type of Business Entity:
Individually Owned  
Partnership  
Corporation  
Limited Liability Co. (LLC)  
Other ______________________________
List below the names, identifying number (social security or FEIN number), and address of all owners, partners, corporate officers, and LLC
members. Attach additional sheets if space is not sufficient.
NAME
SSN/FEIN (Identifying #)
TITLE
HOME ADDRESS
If you are a LLC, are you a
single-member or
multi-member.
For Federal income tax purposes, have you filed Internal Revenue Service (IRS) form 8832 electing to be treated as a corporation?  
Yes   
No  If yes, please attach a copy to this form.
5. List types of tobacco products you plan to distribute: ________________________________________________________________________________
_______________________________________________________________________________________________________________________________
6. List brands you plan to distribute:_________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
7. The Tobacco Master Settlement Complementary Legislation Act requires wholesalers and distributors to submit reports to the Alabama
Department of Revenue that show the total number of cigarettes or in the case of roll-your-own, the equivalent stick count for which the
wholesalers and distributors affixed stamps during the previous month or otherwise paid the tax due. It is unlawful for a wholesaler or
distributor to stamp, sell, offer, or possess for sale cigarettes that are manufactured by a manufacturer that is not in full compliance with this
Act. A wholesaler or distributor can lose their stamping privileges or registration number if they have activity with a manufacturer that is not
in full compliance with the above Act and the NPM Escrow Provisions of Title 6, Chapter 12. Pursuant to the above Act, the statement below
must be signed and notarized in order to complete the application process.
OVER
TOB: APP-R
5/14
A
D
R
LABAMA
EPARTMENT OF
EVENUE
B
& L
T
D
USINESS
ICENSE
Ax
IVISION
Reset
T
T
S
OBACCO
Ax
ECTION
P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627
www.revenue.alabama.gov
Application For Tobacco Stamping Permit
(RESIDENT WHOLESALER)
TO THE ALABAMA DEPARTMENT OF REVENUE:
1. We, _________________________________________________________________________________________, whose place of business is located at
COMPANY NAME
____________________________________________________________________________________________________________________________, in
STREET ADDRESS
_________________________________________________, Alabama __________________ do hereby apply for a wholesaler’s or jobber’s permit as
CITY
ZIP
required by Code of Alabama 1975, Section 40-25-16. If permit is issued, we agree not to pass on any part of the seven and one-half percent
discount allowed by the State on the purchase of stamps. We also furnish the following information:
2. FEIN:
OR SSN:
Telephone Number:
/
3. Contact Person: ______________________________________________________ Title: __________________________________________________
E-Mail Address: ______________________________________________________________________________________________________________
4. Type of Business Entity:
Individually Owned  
Partnership  
Corporation  
Limited Liability Co. (LLC)  
Other ______________________________
List below the names, identifying number (social security or FEIN number), and address of all owners, partners, corporate officers, and LLC
members. Attach additional sheets if space is not sufficient.
NAME
SSN/FEIN (Identifying #)
TITLE
HOME ADDRESS
If you are a LLC, are you a
single-member or
multi-member.
For Federal income tax purposes, have you filed Internal Revenue Service (IRS) form 8832 electing to be treated as a corporation?  
Yes   
No  If yes, please attach a copy to this form.
5. List types of tobacco products you plan to distribute: ________________________________________________________________________________
_______________________________________________________________________________________________________________________________
6. List brands you plan to distribute:_________________________________________________________________________________________________
_______________________________________________________________________________________________________________________________
7. The Tobacco Master Settlement Complementary Legislation Act requires wholesalers and distributors to submit reports to the Alabama
Department of Revenue that show the total number of cigarettes or in the case of roll-your-own, the equivalent stick count for which the
wholesalers and distributors affixed stamps during the previous month or otherwise paid the tax due. It is unlawful for a wholesaler or
distributor to stamp, sell, offer, or possess for sale cigarettes that are manufactured by a manufacturer that is not in full compliance with this
Act. A wholesaler or distributor can lose their stamping privileges or registration number if they have activity with a manufacturer that is not
in full compliance with the above Act and the NPM Escrow Provisions of Title 6, Chapter 12. Pursuant to the above Act, the statement below
must be signed and notarized in order to complete the application process.
OVER
Under penalties of perjury, we hereby certify that we will comply fully with the provisions of the Tobacco Master Settlement Complementary
Legislation Act.
Firm: _______________________________________________________________________________________________________________________
Signature: _____________________________________________________________________________________________________________________
Type or Print Signature Name: ___________________________________________________________________________________________________
Title: __________________________________________________________________________________________________________________________
Sworn to and subscribed before me this the _________ day of____________________________, ___________.
Notary Public: _________________________________________________________________________________________________________________
8. Do you plan to set aside products for shipment out-of-state? 
Yes   
No
9. Indicate if you are a:  
Retailer  
Wholesaler  
Manufacturer or 
Semijobber.
Note: Semijobber is defined as an entity that buys tobacco products from permitted wholesalers or obtains tobacco from other sources and sell at wholesale to
licensed retail dealers for the purpose of resale only.
10. Do you make sales for resale? 
Yes   
No
11. List counties in which you plan to do business: __________________________________________________________________________________
_______________________________________________________________________________________________________________________________
12. Do you sell any taxable tobaccos to any person who is not a legitimate retail dealer? 
Yes   
No
13. Do you sell to anyone under any circumstances any article of tobacco in less than wholesale quantities? 
Yes  
No
14. How many retail stores do you operate in this State engaged in the sale of taxable tobaccos? ___________________________________________
15. Do you operate a retail department and a wholesale department engaged in the sale of taxable tobaccos under the same roof? 
Yes   
No
16. How many sales representatives do you employ soliciting orders of taxable tobacco?__________________________________________________
17. What territory do these representatives cover? ____________________________________________________________________________________
18. How many people do you employ for stamping tobacco? ___________________________________________________________________________
19. Do you keep a permanent record of all taxable tobaccos received by your firm? 
Yes   
No
20. How many delivery trucks do you operate? _______________________
21. Do you distribute tobacco products to individuals operating their own vehicle(s) for distributing or transporting products to others? 
Yes   
No
22. Is your firm one of a chain? 
Yes   
No
If yes, state the name and location of other stores in this chain located within Alabama: _______________________________________________
_______________________________________________________________________________________________________________________________
23. List the name and address of the manufacturers from whom you purchase taxable tobaccos direct (add sheet if needed):
1. __________________________________________________________________________________________________________________________
2. __________________________________________________________________________________________________________________________
3. __________________________________________________________________________________________________________________________
4. __________________________________________________________________________________________________________________________
5. __________________________________________________________________________________________________________________________
24. Do you buy taxable tobaccos from other jobbers? 
Yes   
No   If yes, in what quantities? ______________________________________
25. We must receive a letter of intent from three (3) of your tobacco manufacturers. These letters must state the manufacturer’s intent to sell
tobacco products to your company and must be mailed to our office directly from the manufacturer.
Under penalties of perjury, we hereby certify the above information to be true and correct.
Firm: _____________________________________________________________________________________________________________________________
Signature: ________________________________________________________________________________________________________________________
(If you are a LLC, and all members Do Not sign the application, complete form TOB: LLC-AUTH)
Type or Print Signature Name: ____________________________________________________________________________________________________
Title: _____________________________________________________________________________________________________________________________
Sworn to and subscribed before me this the ________ day of ________________________________, _________.
Notary Public: _____________________________________________________________________________________________________________________
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