Form SBP "Application for Smoking Bar Permit" - Massachusetts

What Is Form SBP?

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

Form Details:

  • The latest edition provided by the Massachusetts 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 printable version of Form SBP by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Revenue.

ADVERTISEMENT
ADVERTISEMENT

Download Form SBP "Application for Smoking Bar Permit" - Massachusetts

964 times
Rate (4.4 / 5) 48 votes
2004–2005
Form SBP
Massachusetts
Application for
Department of
Smoking Bar Permit
Revenue
Legal name of applicant (smoking bar)
Federal Identification or Social Security number
Mailing address
City/Town
State
Zip
Telephone number
Fax number
E-mail address
Business name (if different from legal name)
Name of person authorized to sign declaration below
Business address of smoking bar
City/Town
State
Zip
City/town smoking bar permit or license number (enclose copy of permit or license; if pending, attach copy of application)
City/Town
Massachusetts Department of Revenue license (check all that apply):
Tobacco product manufacturer
Wholesaler
Vending machine operator
Unclassified acquirer
Transportation company
Retailer
Do you currently hold a license to sell tobacco products in the city or town in which the smoking bar is located?
Yes
No
Are you currently registered to remit the cigar excise and file Form Cigar-2?
Yes
No
A permit will not be issued if the applicant is delinquent in filing any required tax returns or has failed to pay any tax due.
The Applicant must attach a copy of either a recently issued Certificate of Good Standing, a Letter of Compliance, or a letter of request consistent with the
requirements of Administrative Procedure 613.
The Commissioner requires that the Applicant maintain records adequate to verify revenues from the sale of tobacco products, food and beverages. The
Commissioner may require the Applicant to provide such additional information as deemed necessary to verify information provided with the application in
accordance with M.G.L. c. 270.
For new businesses
I hereby certify that the applicant anticipates in good faith to generate revenues from the sale of tobacco products equal to or greater than fifty-one percent
of the combined revenue generated by the sale of tobacco products, food and beverages. (Attach a business plan). If a permit is issued as a result of this
application, it is contingent upon the initial quarterly declaration confirming the fifty-one percent requirement and submission of a Certificate of Good Stand-
ing after the first quarter of business. Signed under the pains and penalties of perjury.
Signature of owner or corporate officer
Name (please print)
Title
Date
For all other applicants
I hereby certify that the Applicant had revenues generated from the sale of tobacco products that equaled or exceeded fifty-one percent of the combined rev-
enue generated by the sale of tobacco products, food and beverages for the period indicated below (at least the current quarter, not to exceed four months).
You must submit documentation indicating you are in compliance with the fifty-one percent requirement. Signed under the pains and penalties of perjury.
Signature of owner or corporate officer
Name (please print)
Title
Date
Beginning date
Ending date
For all applicants
I hereby certify that I agree to conform with the provisions of Massachusetts General Laws, Chapters 62C, 64C, 94E, 94F and 270 as amended, and with
all rules and regulations made thereunder, and have complied with all applicable laws of the Commonwealth relating to taxes. Signed under the pains and
penalties of perjury.
Signature of owner or corporate officer
Name (please print)
Title
Date
Mail to: Massachusetts Department of Revenue, PO Box 7004, Boston, MA 02204.
2004–2005
Form SBP
Massachusetts
Application for
Department of
Smoking Bar Permit
Revenue
Legal name of applicant (smoking bar)
Federal Identification or Social Security number
Mailing address
City/Town
State
Zip
Telephone number
Fax number
E-mail address
Business name (if different from legal name)
Name of person authorized to sign declaration below
Business address of smoking bar
City/Town
State
Zip
City/town smoking bar permit or license number (enclose copy of permit or license; if pending, attach copy of application)
City/Town
Massachusetts Department of Revenue license (check all that apply):
Tobacco product manufacturer
Wholesaler
Vending machine operator
Unclassified acquirer
Transportation company
Retailer
Do you currently hold a license to sell tobacco products in the city or town in which the smoking bar is located?
Yes
No
Are you currently registered to remit the cigar excise and file Form Cigar-2?
Yes
No
A permit will not be issued if the applicant is delinquent in filing any required tax returns or has failed to pay any tax due.
The Applicant must attach a copy of either a recently issued Certificate of Good Standing, a Letter of Compliance, or a letter of request consistent with the
requirements of Administrative Procedure 613.
The Commissioner requires that the Applicant maintain records adequate to verify revenues from the sale of tobacco products, food and beverages. The
Commissioner may require the Applicant to provide such additional information as deemed necessary to verify information provided with the application in
accordance with M.G.L. c. 270.
For new businesses
I hereby certify that the applicant anticipates in good faith to generate revenues from the sale of tobacco products equal to or greater than fifty-one percent
of the combined revenue generated by the sale of tobacco products, food and beverages. (Attach a business plan). If a permit is issued as a result of this
application, it is contingent upon the initial quarterly declaration confirming the fifty-one percent requirement and submission of a Certificate of Good Stand-
ing after the first quarter of business. Signed under the pains and penalties of perjury.
Signature of owner or corporate officer
Name (please print)
Title
Date
For all other applicants
I hereby certify that the Applicant had revenues generated from the sale of tobacco products that equaled or exceeded fifty-one percent of the combined rev-
enue generated by the sale of tobacco products, food and beverages for the period indicated below (at least the current quarter, not to exceed four months).
You must submit documentation indicating you are in compliance with the fifty-one percent requirement. Signed under the pains and penalties of perjury.
Signature of owner or corporate officer
Name (please print)
Title
Date
Beginning date
Ending date
For all applicants
I hereby certify that I agree to conform with the provisions of Massachusetts General Laws, Chapters 62C, 64C, 94E, 94F and 270 as amended, and with
all rules and regulations made thereunder, and have complied with all applicable laws of the Commonwealth relating to taxes. Signed under the pains and
penalties of perjury.
Signature of owner or corporate officer
Name (please print)
Title
Date
Mail to: Massachusetts Department of Revenue, PO Box 7004, Boston, MA 02204.