CIGARETTE
LICENSE APPLICATION
TOWN OF OCONOMOWOC
Wisconsin Seller’s Permit Number: _____________________________
(For questions regarding seller’s permit,
call 414-227-4444)
APPLYING
AS:
Individual Partnership Limited Liability Company
Corporation/Nonprofit
Corporation
IF
APPLYING AS AN INDIVIDUAL OR A PARTNERSHIP:
(Please list all partners or the
individual who own the business.)
Name:
___________________________________________________________________
Address: ________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________
(List
any additional partners on the reverse side.)
IF
APPLYING AS A CORPORATION OR A LIMITED LIABILITY COMPANY:
(Please
complete the information below about the business.)
Name
of Corporation:
____________________________________________________
Corporate
Agent:
________________________________________________________
Address:
________________________________________________________________
Business
Telephone:
_____________________________________________________
Trade/Business
Name:
___________________________________________________
The
undersigned hereby applies for a license to manufacture, sell, exchange,
barter, dispose of, or give away cigarette, cigarette paper, cigarette
wrappers, and/or any paper made or prepared for the purpose of being filled
with tobacco for smoking, on said premises.
Please indicate whether sales will be:
Over
the counter Vending
Machine Both
Town of Oconomowoc Name & Address Local Agent (i.e. store
manager)
_______________________________________ _______________________________
_______________________________________ _______________________________
_______________________________________ _______________________________
Cigarette License Fee: $25.00 Each Total Amount Due: $________________
All applicants agree to comply with and be bound by all the laws, ordinances, rules, regulations, and penalties covering the business for which the license(s) is applies. All licenses expire on June 30, ___________.
Date: _________________________ _______________________________________________
(Signature of Applicant)
LIST OF PARTNERS
Name:
___________________________________________________________________
Address:
________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________
Name: ___________________________________________________________________
Address:
________________________________________________________________
Name:
___________________________________________________________________
Address: ________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________
Name: ___________________________________________________________________
Address:
________________________________________________________________
Name:
___________________________________________________________________
Address: ________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________
Name:
___________________________________________________________________
Address:
________________________________________________________________