Form L-917 "Manufacturer's Sales Representatives' License Application for Cigarette, Cigar and Tobacco Products" - South Carolina

What Is Form L-917?

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

Form Details:

  • Released on May 24, 2018;
  • The latest edition provided by the South 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 printable version of Form L-917 by clicking the link below or browse more documents and templates provided by the South Carolina Department of Revenue.

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Download Form L-917 "Manufacturer's Sales Representatives' License Application for Cigarette, Cigar and Tobacco Products" - South Carolina

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STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
MANUFACTURER'S SALES REPRESENTATIVES'
L-917
LICENSE APPLICATION FOR CIGARETTE,
(Rev. 5/24/18)
dor.sc.gov
CIGAR AND TOBACCO PRODUCTS
4062
Notice: A tobacco license will not be issued to a person with any outstanding state tax liability.
1. Applicant's Name
SSN
FEIN
Residence Address
Street or RFD
City
State
Zip
Telephone Number
Email
Vehicle:
Personal
Company
Make
Model
License Number
State
2.
Manufacturer's Name
Address
Street or Box Number
City
State
Zip
NOTE: This office must be notified of any permanent vehicle change that takes place during the licensing period.
3.
Applicant's Supervisor
Telephone Number
Address
Street or RFD
City
State
Zip
4.
List all tobacco products by brands handled by Representative:
5.
Location of facilities used to store tobacco products if other than residence:
6.
Representative's territory:
1) Includes State other than S.C.
Yes
No
If Yes, list other States
2) Includes all of S.C.
Yes
No
If No, list all S.C. Counties
Have you ever been charged with a violation of any type of tobacco tax?
Yes
No
If yes, state nature of violation, date of violation and in which state violation occurred.
I,
swear (or affirm) that the information contained herein is true and correct to the
best of my knowledge and belief.
Signature
Title
Date
Mail to: SC Department of Revenue, P.O. Box 125, Columbia, SC 29214-0400
40621013
STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
MANUFACTURER'S SALES REPRESENTATIVES'
L-917
LICENSE APPLICATION FOR CIGARETTE,
(Rev. 5/24/18)
dor.sc.gov
CIGAR AND TOBACCO PRODUCTS
4062
Notice: A tobacco license will not be issued to a person with any outstanding state tax liability.
1. Applicant's Name
SSN
FEIN
Residence Address
Street or RFD
City
State
Zip
Telephone Number
Email
Vehicle:
Personal
Company
Make
Model
License Number
State
2.
Manufacturer's Name
Address
Street or Box Number
City
State
Zip
NOTE: This office must be notified of any permanent vehicle change that takes place during the licensing period.
3.
Applicant's Supervisor
Telephone Number
Address
Street or RFD
City
State
Zip
4.
List all tobacco products by brands handled by Representative:
5.
Location of facilities used to store tobacco products if other than residence:
6.
Representative's territory:
1) Includes State other than S.C.
Yes
No
If Yes, list other States
2) Includes all of S.C.
Yes
No
If No, list all S.C. Counties
Have you ever been charged with a violation of any type of tobacco tax?
Yes
No
If yes, state nature of violation, date of violation and in which state violation occurred.
I,
swear (or affirm) that the information contained herein is true and correct to the
best of my knowledge and belief.
Signature
Title
Date
Mail to: SC Department of Revenue, P.O. Box 125, Columbia, SC 29214-0400
40621013