RT-01
October 2014
CHEROKEE NATION TAX COMMISSON
PO BOX 948
TAHLEQUAH, OK 74465
BUSINESS LICENSE APPLICATION
PLEASE PRINT OR TYPE INFORMATION
A. Type of Business License Applied for:
□ Retail Tobacco
(Cigarette and Tobacco Products)
□ Wholesale Tobacco
□ Retail Sales
□ Vending Machine-Tobacco
□ Special Events
□ Alcohol
□ Other _____________________
B. Indicate the reason(s) for filing this form:
□ New Business
□ Additional licenses/permits
□ Change in business location
□ Change in business ownership
□ Change of Name
□ Other _____________________
C. Business Identification
□ Individual
□ General Partnership
□ Limited Partnership
□ Cherokee Nation Corporation
□ Foreign Corporation
□ Other _____________________
D. Check applicable fees:
□ Initial Application Fee…..$100
□ Retail Sales………………$20
□ Retail Tobacco…………..$20
□ Wholesale Tobacco……..$20
□ Alcohol………………….$20
□ Vending Permit …………$45
□ Retail Sales Renewal ……$20
□ Retail Tobacco Renewal ..$20
□ Other ___________________
OFFICE USE ONLY
Date Received: ___________________
Approved: ___________________
Denied: ___________________
Open Date: ___________________
BUSINESS INFORMATION
BUSINESS NAME BUSINESS PHONE (AREA CODE AND NUMBER)
ADDRESS BUSINESS OFFICE (STREET AND NUMBER, PO BOX, RURAL ROUTE AND BOX NUMBER) CITY STATE ZIP
LEGAL OWNERSHIP
NAME OF LEGAL OWNER, INDIVIDUAL, PARTNERSHIP OR CORPORATION FEDERAL EMPLOYER’S IDENTIFICATION NUMBER (EIN)
ADDRESS BUSINESS OFFICE (STREET AND NUMBER, PO BOX, RURAL ROUTE AND BOX NUMBER) CITY STATE ZIP
NAME OF OFFICER OR EMPLOYEE RESPONSIBLE FOR REMITTING APPLICBLE TAX:
NAME (LAST, FIRST, MIDDLE INITIAL) PHONE NUMBER TITLE
ADDRESS BUSINESS OFFICE (STREET AND NUMBER, PO BOX, RURAL ROUTE AND BOX NUMBER) CITY STATE ZIP
A SOLE OWNER: GENERAL PARTNER, A CORPORATE OFFICER; OR AUTHORIZED REPRESENTATIVE MUST SIGN THIS
APPLICATION BELOW:
I, the undersigned applicant or authorized representative, declare under the penalties of perjury, revocation of license, and other penalties of law
that I have examined this application and attachments and to the best of my knowledge the facts and representations set forth are true and correct,
that I have read and understand the Cherokee Nation Tax Code and the Cherokee Nation Tax Commission Regulations, that I will comply with
the Cherokee Nation Tax Code and the Cherokee Nation Tax Commission Regulations, and that I will report to the Cherokee Nation Tax
Commission within ten (10) day of occurrence any variance or violation of the laws of the Cherokee Nation or the regulations of the Cherokee
Nation Tax Commission.
TYPE OR PRINT NAME AND TITLE SIGNATURE DATE
MAKE CHECKS PAYABLE TO
CHEROKEE NATION TAX COMMISSION
918-453-5000 EXT 3821/3974 * FAX 918-458-7618
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