Is this application for a new license or renewal?=IF([[is_a_pre_existing_license_YN]]==1,'Renewal','New License')
Which pre-existing license do you want to renew?[[selected_pre_existing_license]]
Registration Number[[registration_number]]Status: [[status]]
License Type
Registrant Information
Registrant Contact:[[registrant_contact]]
Registrant Name:[[registrant_display_name]]
Registrant Phone:[[registrant_phone]]
Registrant Email:[[registrant_email]]
Is registrant the manager of business?=IF([[is_registrant_the_owner_of_business]]==1,'Yes','No')
Manager First Name:[[manager_first_name]]
Manager Last Name:[[manager_last_name]]
Business Information
Registrant Organization:[[registrant_organization]]
Organization Name:[[organization_name]]
Legal Entity Type:[[legal_entity_type]]
FEIN Number:[[fein_number]]
Does this organization have a different alias DBA name?=IF([[is_dba_name_org_name_yn]]==1,'Yes','No')
Organization DBA Name:[[organization_dba_name]]
State Sales Tax Number:[[state_sales_tax_number]]
Is there a different mailing address?=IF([[is_there_a_different_mailing_address]]==1,'Yes(Provide)','No')
Business Physical Address:[[business_physical_address]]
Mailing Address:[[mailing_address]]
General Information
Does applicant understand that tobacco products cannot legally be sold in the Town of Keystone (Town) without a Retail Tobacco Business License?=IF([[question_general1b_yn]]==1,'Yes','No')
Does applicant understand that a License, if approved, must be renewed annually?=IF([[question_general2_yn]]==1,'Yes','No')
Does the applicant understand that the legal age to purchase tobacco in the Town is 21 years?=IF([[question_general3a_yn]]==1,'Yes','No')
Does applicant understand Licensee must instruct all employees that selling tobacco products to persons under the age of 21 years is against the law?=IF([[question_general3b_yn]]==1,'Yes','No')
Does the applicant understand that the License must be displayed in a publicly visible location inside the licensed premise (Licensed Premises)? =IF([[question_general4_yn]]==1,'Yes','No')
Does the applicant understand the minimum legal sales age to purchase tobacco products (21) must be prominently displayed at licensed premise locations?=IF([[question_general5_yn]]==1,'Yes','No')
Signature Details
Signature:
Signature Date Submitted:[[signature_date_submitted]]
