Form TOB: APP-NR "Application for Tobacco Stamping Permit (Non-resident Wholesaler)" - Alabama

What Is Form TOB: APP-NR?

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-NR 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-NR "Application for Tobacco Stamping Permit (Non-resident Wholesaler)" - Alabama

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TOB: APP-NR
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P.O. Box 327555 • Montgomery, AL 36132-7555 • (334) 242-9627
www.revenue.alabama.gov
Application For Tobacco Stamping Permit
(NON-RESIDENT WHOLESALER)
1. Business Name: ___________________________________________________________________________________________________________
2. Address: _________________________________________________________________________________________________________________
3. City: ________________________________________________________ State: ___________________________ Zip: _______________________
4. FEIN:
OR SSN:
Telephone number:
/
5. Contact Person: _____________________________________________________________ Title: ________________________________________
E-Mail Address: __________________________________________________________________________________________________________
6. 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.
7. List types of tobacco products you plan to distribute: __________________________________________________________________________
_________________________________________________________________________________________________________________________
8. List brands you plan to distribute: ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________
OVER
TOB: APP-NR
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
(NON-RESIDENT WHOLESALER)
1. Business Name: ___________________________________________________________________________________________________________
2. Address: _________________________________________________________________________________________________________________
3. City: ________________________________________________________ State: ___________________________ Zip: _______________________
4. FEIN:
OR SSN:
Telephone number:
/
5. Contact Person: _____________________________________________________________ Title: ________________________________________
E-Mail Address: __________________________________________________________________________________________________________
6. 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.
7. List types of tobacco products you plan to distribute: __________________________________________________________________________
_________________________________________________________________________________________________________________________
8. List brands you plan to distribute: ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________
OVER
9. 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.
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: ____________________________________________________________________________________________________________
10. 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.
11. Do you make sales for resale?  
Yes   
No
12. Are you a licensed tobacco wholesaler in your state?  
Yes   
No
Permit number: ___________________________________________ Cancellation number: __________________________________________
13. Are sales of tobacco products in Alabama made only to licensed retail dealers?  
Yes   
No
14. How many retail stores selling tobacco products are operated in Alabama under your ownership, supervision, or management? ________
15. How many sales representatives are employed soliciting orders of tobacco products in Alabama? _______________
16. How will you distribute tobacco products into Alabama?  
Company vehicle(s)   
Common Carrier   
Mail Order   
Other (please explain) __________________________________________________________________________________________________
17. How many trucks delivering tobacco products do you operate in Alabama? ______________
18. List counties in which you plan to do business: _______________________________________________________________________________
_________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________
(If you are a LLC, and all members Do Not sign the application, complete form TOB: LLC-AUTH)
19. We must receive a letter of intent from three (3) of your tobacco manufacturers. These letters must state the manufac turer’s intent to
sell tobacco products to your company. In addition to the letters from the manufacturers, we require a letter from your resident state
indicating that your company is a duly qualified wholesaler in accordance with all laws, rules, and regulations with regard to selling
tobacco products in the state. These letters must be mailed to our office directly from the manufacturers and the resident state.
Under penalties of perjury, we hereby certify the above information to be true and correct.
Firm: ________________________________________________________________________________________________________________________
Signature: ____________________________________________________________________________________________________________________
Type or Print Signature Name: __________________________________________________________________________________________________
Title: ________________________________________________________________________________________________________________________
Sworn to and subscribed before me this the __________ day of __________________________, __________.
Notary Public: __________________________________________________________
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