Application Or Renewal Requirements For Applicants And Licensees Under Article 2A

# (a)

A distributor obtaining, renewing, or updating a license pursuant to G.S. 105-113.12 shall use Form B-A-2.

# (b)

A wholesale dealer or retail dealer obtaining, renewing, or updating a license pursuant to G.S 105-113.36 shall use Form B-A-2.

# (c)

Form B-A-2 requires the following:

# (1)

a description of the transactions requested, including: (A) a designation of whether the applicant or licensee is requesting an initial license, renewing a license, or updating information previously submitted on the form; (B) the applicant's or licensee's business structure, such as a sole proprietorship, partnership, corporation, limited liability company, limited liability partnership; (C) if requesting a new license or renewal of an existing license, the type of license requested; (D) the seven digit number assigned by the North Carolina Secretary of State, if applicable; and (E) the total payment due;

# (2)

the applicant's or licensee's business information, including: (A) information required by 17 NCAC 01C .0322(b); (B) the legal name; (C) the date the business began operations; (D) the trade name or doing-business-as name, if applicable; (E) the physical location where non-tax-paid tobacco products are manufactured, received, or stored; (F) the mailing address; (G) the location where records are kept; (H) the e-mail address, if available; and (I) if the applicant or licensee elects to designate a contact person, the identity of the contact person including his or her legal name, telephone number, fax number, and e-mail address;

# (3)

the identity of the applicant's or licensee's owners, officers, partners, or members, and for each person identified, their: (A) social security number, if a natural person; (B) legal name; (C) job title; (D) residential address; (E) phone number; and (F) misdemeanor or felony convictions, if any, and a statement describing the circumstances of the conviction, including the offense, date of offense, date of conviction, case number, court jurisdiction, and any active terms of probation;

# (4)

the identity of persons who previously held an ownership interest in the applicant, and for each person identified: (A) their legal name; (B) the name of business at the time the interest was held; (C) the address of business at the time the interest was held; and (D) the last date of ownership in the applicant or licensee;

# (5)

if any person identified on the form previously owned, operated, or managed another legal entity selling, receiving, or purchasing tobacco products, the applicant or licensee shall include for each person identified: (A) the person's legal name; (B) the person's social security number; (C) the person's residential address; (D) the name of the legal entity; and (E) the person's job title held at the legal entity;

# (6)

a description of the applicant's or licensee's operations, including:

(A) a designation of whether the applicant or licensee is a resident, nonresident, affiliated manufacturer, or integrated wholesaler;

(B) the percentage of operations that are associated with retail, distribution or wholesale, manufacturing, or other activities;

(C) the number of locations storing non-tax-paid tobacco products and the physical address for each location;

(D) the number of locations storing tax-paid tobacco products and the physical address for each location;

(E) the date when the applicant or licensee began or intends to begin to sell non-tax-paid tobacco products;

(F) a designation of whether a surety bond or letter of credit is included with the form;

(G) a designation of whether the applicant or licensee currently or intends to buy or sell tobacco products by Internet, telephone, catalog, or any other means that would qualify as a delivery sale;

(H) a designation of whether the applicant or licensee currently or intends to buy or sell roll-your own cigarette tobacco;

(I) a designation of whether the applicant or licensee currently or intends to import tobacco from out-of-country vendors;

(J) if the applicant or licensee is a nonresident distributor or wholesale dealer, designating whether the applicant or licensee is licensed in the applicant's or licensee's state of residence;

(K) a designation of whether the applicant or licensee currently or intends to purchase vapor products;

(L) a list of all states where the applicant or licensee holds a tobacco products license and the license number for each license;

(M) if the applicant or licensee is applying for a distributor's license: (i) a list of all manufacturers that will sell to the applicant or licensee non-tax-paid cigarettes; (ii) the address and phone number of all manufacturers that will sell to the applicant or licensee non-tax-paid cigarettes; (iii) a letter from those manufacturers affirming the manufacturers intent to sell to the applicant or licensee non-tax-paid cigarettes; and (iv) a list of all cigarette brands the applicant or licensee intends to sell;

(N) if the applicant or licensee is applying for wholesale dealer's or retail dealer's license: (i) a list of all suppliers providing the applicant or licensee other tobacco products where the excise tax under G.S. 105-113.35 or G.S. 105-113.35A has not been paid; (ii) the supplier's legal name; (iii) the supplier's address; (iv) the supplier's telephone number; (v) for each supplier, the date the applicant or licensee first purchased other tobacco products from the supplier; and (vi) the delivery method for each supplier not located in this State; and (O) a list of roll-your-own cigarette tobacco brands that the applicant or licensee intends to sell, if any; and (7) for the person authorized to legally bind the applicant or licensee, his or her:

(A) typed legal name;

(B) job title;

(C) signature;

(D) date of signature;

(E) telephone number;

(F) fax number;

(G) e-mail address; and (H) affirmation that the form is accurate and complete.