Form B-A-2 "Application or Update to an Existing Application for Cigarette Distributor's License and Tobacco Products (Other Than Cigarettes) License" - North Carolina

What Is Form B-A-2?

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

Form Details:

  • Released on October 1, 2019;
  • The latest edition provided by the North Carolina 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 B-A-2 by clicking the link below or browse more documents and templates provided by the North Carolina Department of Revenue.

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Download Form B-A-2 "Application or Update to an Existing Application for Cigarette Distributor's License and Tobacco Products (Other Than Cigarettes) License" - North Carolina

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4
B-A-2
PRINT
CLEAR
Application or Update to an Existing Application
for Cigarette Distributor’s License and Tobacco
Web-Fill
10-19
Products (Other Than Cigarettes) License
Section I: Transaction Requested
Application Transaction
Type of Business
Department Use Only
Individual / Sole Proprietor
Initial License
NCDORID:
Partnership
Renewal Application
Corporation
Change to Ownership Parties
LLC or LLP
Date License Issued
(MM/DD/YYYY):
Change to Type of Business
Enter the 7-digit Entity Number assigned by the North Carolina
Secretary of State’s office. All businesses, except sole proprietorships
Change of Business Name
and general partnerships, must have an entity number to submit this
/
/
application.
Change of Location Address
License Type
Tax Due Total License Tax Due
(Check or Money Order ONLY)
(Check at least one box)
Cigarette
Cigarette Distributor
Cigarette Manufacturer
$25.00
Other Tobacco Product (OTP)
OTP Wholesale Dealer
OTP Manufacturer
(covers wholesale and
$25.00
retail liability, if both)
Other Tobacco Product (OTP)
OTP Retail Dealer (only)
$10.00
TOTAL
Add all license tax due together for a total License Tax due amount for an initial license only.
Make check or money order payable to North Carolina Department of Revenue.
$
Do not send cash as your application will NOT be processed.
Section 2: Business Information
Federal Employer Identification Number / Social Security Number:
LEGAL NAME OF APPLICANT (This is the name the license will be issued in)
DATE BUSINESS OPENED (MM/DD/YYYY)
TRADE NAME OR DBA (IF DIFFERENT FROM LEGAL NAME)
Physical Location – A tobacco product license is required for each place of business where non-tax-paid cigarettes are received or stored, where tobacco
products other than cigarettes are manufactured, and where non-tax-paid tobacco products other than cigarettes are received or stored.
Submit a separate application for each place of business.
PHYSICAL LOCATION ADDRESS (NOT P.O. Box or Route Number)
CITY
STATE
ZIP CODE
MAILING ADDRESS
CITY
STATE
ZIP CODE
LOCATION OF RECORDS (NOT P.O. Box or Route Number)
CITY
STATE
ZIP CODE
E-MAIL ADDRESS
WEBSITE ADDRESS (Optional)
4
B-A-2
PRINT
CLEAR
Application or Update to an Existing Application
for Cigarette Distributor’s License and Tobacco
Web-Fill
10-19
Products (Other Than Cigarettes) License
Section I: Transaction Requested
Application Transaction
Type of Business
Department Use Only
Individual / Sole Proprietor
Initial License
NCDORID:
Partnership
Renewal Application
Corporation
Change to Ownership Parties
LLC or LLP
Date License Issued
(MM/DD/YYYY):
Change to Type of Business
Enter the 7-digit Entity Number assigned by the North Carolina
Secretary of State’s office. All businesses, except sole proprietorships
Change of Business Name
and general partnerships, must have an entity number to submit this
/
/
application.
Change of Location Address
License Type
Tax Due Total License Tax Due
(Check or Money Order ONLY)
(Check at least one box)
Cigarette
Cigarette Distributor
Cigarette Manufacturer
$25.00
Other Tobacco Product (OTP)
OTP Wholesale Dealer
OTP Manufacturer
(covers wholesale and
$25.00
retail liability, if both)
Other Tobacco Product (OTP)
OTP Retail Dealer (only)
$10.00
TOTAL
Add all license tax due together for a total License Tax due amount for an initial license only.
Make check or money order payable to North Carolina Department of Revenue.
$
Do not send cash as your application will NOT be processed.
Section 2: Business Information
Federal Employer Identification Number / Social Security Number:
LEGAL NAME OF APPLICANT (This is the name the license will be issued in)
DATE BUSINESS OPENED (MM/DD/YYYY)
TRADE NAME OR DBA (IF DIFFERENT FROM LEGAL NAME)
Physical Location – A tobacco product license is required for each place of business where non-tax-paid cigarettes are received or stored, where tobacco
products other than cigarettes are manufactured, and where non-tax-paid tobacco products other than cigarettes are received or stored.
Submit a separate application for each place of business.
PHYSICAL LOCATION ADDRESS (NOT P.O. Box or Route Number)
CITY
STATE
ZIP CODE
MAILING ADDRESS
CITY
STATE
ZIP CODE
LOCATION OF RECORDS (NOT P.O. Box or Route Number)
CITY
STATE
ZIP CODE
E-MAIL ADDRESS
WEBSITE ADDRESS (Optional)
Page 2,
Legal Name
FEIN / SSN
B-A-2, Web-Fill, 10-19
Contact Persons: North Carolina General Statutes 105-259 states that all tax records and information maintained by the North Carolina Department
of Revenue are confidential. The tax information may only be given to a business owner, partner, member, or officer. If you wish to give an employee,
attorney, or accountant access to your tax information, you must submit a power of attorney, Form Gen 58, authorizing the release of confidential tax
information. Download Form Gen-58 at www.ncdor.gov
CONTACT PERSONS
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
License Contact
Reporting Contact
Section 3: Identification of Owners / Officers / Partners / Members
(Attach additional sheets, if necessary)
SOCIAL SECURITY
LEGAL NAME
COMPLETE RESIDENCE ADDRESS
TITLE
RESIDENCE PHONE
NUMBER
(First, Middle Initial, Last Name)
(Home Address)
Have any of the individuals listed above ever been convicted of a felony or misdemeanor other than a minor traffic offense?
If yes, attach an explanation to this application, including offense charged, convicted offense, date of conviction,
Yes
No
(Check One)
case number and court jurisdiction, any active terms of probation.
Previous Owner Information: Names of any persons who previously held any ownership interest in this business
(Attach additional sheets
if necessary)
NAME OF PREVIOUS OWNER
NAME OF PREVIOUS BUSINESS
DATE CLOSED
PHYSICAL ADDRESS OF PREVIOUS BUSINESS
Identification of Previous Association: Names of any persons associated with this license application who presently or previously
owned, operated, or managed another cigarette or tobacco product other than cigarette business.
(Attach additional sheets, if necessary)
SOCIAL
COMPLETE RESIDENCE ADDRESS
NAME
NAME OF ASSOCIATED BUSINESS
TITLE
SECURITY
(Home Address)
NUMBER
Section 4: Business Operations Information
1. Applicant is:
Resident
Nonresident
Affiliated Manufacturer
Integrated Wholesaler
2. Describe business activity and select all boxes that apply to your business. If more than one activity, provide percentage of each
activity:
Retail _______%
Distribution/Wholesale ________%
Manufacturer ________%
Other _________%
3. Number of locations storing non-tax-paid product. (Attach a list of all physical locations if more than one): ______________
4. Number of locations storing tax-paid product. (Attach a list of all physical locations if more than one): ______________
5. Beginning date of tobacco sales in North Carolina: ______________
6. Tobacco Products licensees are required to maintain a bond or irrevocable letter of credit in the amount of two-times the average
expected monthly tax liability, with a $2,000.00 minimum and $2,000,000.00 maximum.
Select the appropriate box indicating which type of document you have submitted with the application:
Surety Bond
Letter of Credit
7. Will you buy tobacco products by
internet
telephone
catalog? (Check all that apply.)
8. Will you sell tobacco products by
internet
telephone
catalog? (Check all that apply.)
Page 3,
Legal Name
FEIN / SSN
B-A-2, Web-Fill, 10-19
9. Will you be buy Roll-Your-Own (RYO) Cigarette Tobacco?
Yes
No
10. Will you be sell Roll-Your-Own (RYO) Cigarette Tobacco?
Yes
No
11. Will you be importing Tobacco from Out-of-Country Vendors?
Yes
No
12. If a nonresident Cigarette distributor or OTP wholesale dealer, are you licensed in your State of Residence?
Yes
No
13. Do you purchase vapor products?
Yes
No
List all other states in which you hold a cigarette and/or other tobacco products license.
(Attach additional list, if necessary)
State
License Number
State
License Number
If applying for a cigarette distributor’s license, list ALL manufacturers from whom you have a letter stating that they will sell you non-tax-
paid cigarettes upon licensure from this department. (Attach a copy of each letter of intent received from a manufacturer).
(Attach additional sheets, if necessary)
Manufacturer Name
Complete Address
Telephone Number
If applying for a cigarette distributor’s license, list ALL the Cigarette Brands you intend to sell.
(Attach additional sheets, if necessary)
If applying for an OTP wholesale or retail dealer license, list the supplier of your non-tax-paid tobacco products other than cigarettes
(OTP). If receiving OTP from an out-of-state supplier, indicate the delivery method into North Carolina.
(Attach additional sheets, if necessary)
Telephone
Date of First
Method of
Supplier Name
Complete Address
Number
Purchase
Shipping
Page 4,
Legal Name
FEIN / SSN
B-A-2, Web-Fill, 10-19
If applying for an OTP wholesaler dealer license, list ALL the Roll-Your-Own (RYO) Cigarette Tobacco Brands you intend to sell.
(Attach
additional sheets, if necessary)
Section 5: Certification
This application must be signed by a business owner, partner, member, or officer with the authority to
legally bind the business entity.
I certify that I have read this application, and know and understand its contents and that all the information herein is true and accurate. I
understand it is unlawful to knowingly make a false statement on the application and that any violation may result in prosecution as well
as the revocation of any tobacco product license. I certify that I am of legal age to sell cigarettes and/or other tobacco products.
NAME (PLEASE PRINT OR TYPE)
TITLE
SIGNATURE
DATE
TELEPHONE NUMBER
FAX NUMBER
E-MAIL ADDRESS
NOTE: Distributors, retailers, and wholesale dealers are required to secure a separate license for each place of business, whether
established or temporary, from which non-tax-paid cigarettes are received or stored and/or non-tax-paid tobacco products other
than cigarettes OTP are made, received or stored. A separate application and bond or irrevocable letter of credit must be
submitted for each place of business. The Excise Tax Division reserves the right before issuing a Distributor’s License, Retail
License, or Wholesale Dealer’s License to conduct an investigation of the activities of the applicant. Any false misleading
information found in this application shall be cause for the denial of issuance or revocation of the license.
If for any reason you cease to sell cigarettes and/or other tobacco products (OTP) during the license period, you must notify the
Department and return your license to the address below. Mark the license “Canceled” with the date of cancellation.
Required attachments for the approval process:
Applications requesting an initial cigarette distributor license must be submitted with a completed form B-A-30, Tax Bond for Cigarettes,
or an Irrevocable Letter of Credit (ILOC) with a bond or ILOC in the amount of two (2) times the average expected monthly tax liability, but
not less than $2,000.00, nor more than $2,000,000.00, and a letter(s) of intent from each manufacturer.
Applications requesting an initial tobacco products other than cigarettes (OTP) wholesale or retail dealer’s license must be submitted with
a completed form B-A-29, Tax Bond for Tobacco Products Other Than Cigarettes, or an Irrevocable Letter of Credit (ILOC) with a bond or
ILOC in the amount of two (2) times the average expected monthly tax liability, but not less than $2,000.00, nor more than $2,000,000.00.
Applications requesting an initial cigarette distributor license or an initial tobacco products other than cigarettes license, submitted by an
Individual/Sole Proprietor or a General Partnership, must submit Form B-A-28, Appointment of Secretary of State for Service of Process.
Download forms at www.ncdor.gov.
Submit this application to the address below. Failure to answer all questions, provide the requested documents, include a
check or money order payable to the North Carolina Department of Revenue for the applicable license tax, remit the appropriate
bond or irrevocable letter of credit, will constitute cause for rejection of your application by the North Carolina Department of
Revenue.
North Carolina Department of Revenue
1429 Rock Quarry Road, Suite 105, Raleigh, North Carolina 27610
Phone Number: (919) 707-7500 Toll Free: (877) 308-9092
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