Form 70-015a - Annual Application For Iowa Cigarette Permit/tobacco Tax License - 2000

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Annual Application for Iowa Cigarette Permit/Tobacco Tax License
July 1, 20_____ to June 30, 20_____
Legal Business Name:
Business/Trade Name:
N
A
Mailing Address of Business:
M
E
Location Address of Business:
A
N
Iowa Warehouse Location:
D
Permit Contact Name
A
D
Report/Return Contact Name
D
R
E
Type of Ownership:
S
S
List other Department of Revenue and Finance permit numbers currently in effect for this business.
Identify partners or corporate officers.
L
601
___ 601 & 606
I
606
C
E
602
___ 604 & 605
N
S
603
E
604
T
605
List the permit/license type for the duplicate needed
Y
P
607
E
608
Bond Type:
Surety Co:
Bond No:
Bond Amount:
ADDITIONAL REQUIREMENTS AND GENERAL INSTRUCTIONS ON REVERSE SIDE.
70-015a (7/14/00)

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