Form Cig-App Fillable Application for Cigarette and Other Tobacco Products Licenses
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

By Checking This Box You Certify You Are Compliant With the Master Settlement Agreement And Any And All TO SPEAK TOTHE STATE OF NEVADA STATE FIRE MARSHALLS OFFICE PLEASE CALL: 775 684 7526 ( ) Ext: (If Applicable Please Attach Copies Of Said Licenses) 1550 College Parkway Suite 115 A minimum $1000 00 security bond is required for all Cigarette Wholesale Dealers (NRS 370 155) All Applicants Please List Three References With Whom You Have Done Business: All That Apply: Application for Cigarette Wholesale License Cigarette BEFORE ANY MANUFACTURER CAN SELL CIGARETTES IN THE STATE OF NEVADA THEY MUST FIRST SUBMIT A LIST OF BRANDS AS FIRE STANDARD COMPLIANT IF YOU HAVE NOT SPOKEN TO THE CHIEF TOBACCO COUNSEL AT THE ATTORNEY Business Fax Number: ( ) Business Telephone Number: ( ) By Checking This Box You Certify Your brands you intend to sell in this State have been approved as Fire Standard Compliant Carson City Nevada 89706 7937 Cigarette Wholesale License Fee is $150 00 annually (NRS 370 150) or prorated by quarter as follows: CIGARETTES BY BRAND AND STYLE THEY INTEND TO SELL IN THIS STATE TO THE NEVADA DEPARTMENT OF ATTORNEY Complete the Following Information: Contact Fax Number: Contact Telephone Number: Corporate Address: Corporation Name: Date Incorporated: Date You Intend To Start Selling Tobacco Products: Date: Department of Taxation DIRECTORY THEY MAY NOT BE SOLD IN THIS STATE Does Applicant Hold a State County Or City License? Doing Business As: Federal Identification Number: firm name certificate GENERALS OFFICE AND THEY MUST ALSO CONTACT THE STATE OF NEVADA FIRE MARSHALLS OFFICE TO REGISTER SAID GENERALS OFFICE PLEASE CALL (775) 688 1818 Has Applicant or Person(s) Directly or Indirectly Owning 10 Percent or More of Said Business Been Convicted of a Crime If Applicant is Filing for a Cigarette Manufacturer Dealers License Please If Applicant is Filing foraCigaretteWholesaleDealers LicensePlease If Applicant will Apply Nevada Indicia to Packages of Cigarettes If operating under a fictitious firm name within the state of Nevada please attach a certified copy of the fictitious IF SAID APPLICANTS CIGARETTES OR ROLL YOUR OWN BRANDS ARE NOT LISTED ON THE NEVADA STATE TOBACCO If So Please Explain in Detail or Attach Additional Information Regarding the Charge: If Yes Please Provide Stamp Machine Serial If Yes Where? Is Statement Recorded? Jan Mar $150 00 Apr June $112 50 July Sept $75 00 Oct Dec $37 50 List All Brand and Styles Applicant Will Be Selling Within The State of Nevada (If Needed Attach a List): List All Owners Partners Corporate Officers Managers Members etc (If individual ownership list only one owner ) Attach Additional Sheets if List Names Addresses and Phone Numbers of Current Suppliers (If Needed Attach a List): List Names Addresses and Phone Numbers of People You Intend on Conducting Business With (If Needed Attach a List): List the Cigarette Brands You Intend to Sell (If Needed Attach a List): Location Mailing Address: Location Physical Location: Manufacturer License Tobacco Retail License and Other Tobacco Name and Address Name and Address Name: Name: Needed Number: Operating Under a Fictitious Firm Name? Owned: Owned: Owner/Partner Names (or) Corporate Officers: Percent Percent Person to Contact Regarding Monthly Returns: Phone (775) 684 2000 Fax (775) 684 2020 Please Check Please Check Box Please Indicate the Date Your Cigarette Inventory Will Always Exceed $10 000 00 Wholesale Value: Please List Other States in Which Applicant Holds A Retail or Wholesale Cigarette License: Please Print Name: Please Provide One E mail Address For The Person Who Will Receive Notifications Of Changes To The State of Nevada Please Sign Name: Products Wholesale License Regulations And/Or Laws That Are Specified Within This Section: Relating to Tobacco? Residence Address: Residence Address: SSN#: SSN#: State Zip State Zip Title: Title: Title: Tobacco Directory: Type Of Business (Owner Partnership Corporation Other): Web Site: http://tax nv gov Where? Wholesale Cigarette Manufacturer Cigarette Other Tobacco Products Wholesale Tobacco Retail with the Nevada State Fire Marshalls Office: