This type of retail location typically sells a wide variety of products so that the sale of tobacco products, electronic cigarette products, and nicotine products* accounts for less than 35% of the total quarterly gross receipts. In addition, less than 20% of the retail floor space and less than 20% of the total shelf space is allocated to the offer, display or storage of tobacco products. There is no self-service display for tobacco products, electronic cigarettes, or nicotine products. The business does not sell any flavored electronic cigarette products**. Lastly, the business does not hold itself out as a retail tobacco specialty business and cause a reasonable person to believe the commercial establishment is a retail tobacco specialty business.
I understand that in order to be permitted as a General Tobacco Retailer, the business identified in this application may NOT at any time:
I understand that retailers are responsible for knowing and complying with local, state, and federal laws and regulations. I further understand, and my signature binds all proprietors for the business, that if any requirements for a General Tobacco Retailer are violated, this permit may be revoked by the issuing health department.
This type of retail location typically specializes in the sale of tobacco products, electronic cigarette products, and/or nicotine products*
I understand that in order to be permitted as a Retail Tobacco Specialty Business, the business identified in this application may NOT at any time, be within:
I understand that retailers are responsible for knowing and complying with local, state, and federal laws and regulations.
I further understand, and my signature binds all proprietors for the business, that if any requirements for a Retail Tobacco Specialty Business are violated, this permit may be revoked by the issuing health department.
A map of the proposed retail tobacco specialty business location is attached that shows the location of any community location***, other retail tobacco specialty business, agricultural or residential property. The retail tobacco specialty business application cannot be processed without the map.
*Tobacco products include any cigar, cigarette, electronic cigarette, chewing tobacco, or any substitute for a tobacco product, including flavoring or additives to tobacco, and tobacco paraphernalia. Electronic cigarette products include any electronic cigarette, electronic cigarette substance, or a prefilled electronic cigarette. Nicotine product includes any alternative nicotine product or a nontherapeutic nicotine product. Please refer to Utah Code 76-10-101 for specific definitions.
**Utah Code 76-10-101(7) definition: “Flavored electronic cigarette product” includes an electronic cigarette product that has a taste or smell of any fruit, chocolate, vanilla, honey, candy, cocoa, dessert, alcoholic beverage, herb, or spice. “Flavored electronic cigarette product” does not include an electronic cigarette product that: has a taste or smell of only tobacco, mint, or menthol; or has been approved by an order granting a premarket tobacco product application of the electronic cigarette product by the United States Food and Drug Administration under 21 U.S.C. Sec. 387j(c)(1)(A)(i).
***Community location: public or private K-12 school, licensed child-care or preschool, trade or technical school, church, public library, public playground, public park, youth center or other place used primarily for youth oriented activities, public recreational facility, public arcade, homeless shelter.
Section 2: Business Information Please list the information about the physical location of the business.
Section 3: Contact and Mailing Information An individual to contact about the application and other permit-related notices must be included.
Section 4: Owner/Proprietor Information Must include information for each individual that is a proprietor or owner. If the proprietor is a corporation, must also include corporate ownership information.
Proprietor 1
Proprietor 2
Have any of the owners/proprietors for the business violated any state or federal tobacco laws in the past 24 months? If so, list all violations and dates of each violation:
Section 5: Tax Commission Tobacco License Attach a copy of the store’s current tax commission tobacco license. The application cannot be processed without a current license.
Section 6: Permit Fees
Payment must be submitted with the application. No permit will be issued without the payment of the permit fee. A plan review will not be conducted until payment of the plan review fee. It is the responsibility of the applicant to verify zoning and proximity restrictions. Fees cannot be refunded if it is later determined that the identified location does not meet zoning or proximity requirements.
New Permit: $30.00 Permit Renewal: $20.00 Permit Reinstatement: $30.00 Retail Tobacco Specialty Business Plan Review: $250.00 (required for all new retail tobacco specialty business permit applications)
Section 7: Acknowledgement / Agreement
I certify that the information provided is true and accurate. I understand that any incorrect information may result in the suspension or revocation of the tobacco retailer permit. I also understand that the health department may recommend to the business licensing entity that the business license be suspended or revoked. Any such action will be reported to the Utah State Tax Commission.
By clicking submit I am signing this application and my signature binds all proprietors for the business to the above agreements.
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