Merchants Affidavit For Delivery Sales Of Cigarette And Tobacco Products
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Merchants Affidavit For Delivery Sales Of Cigarette And Tobacco Products Form. This is a Indiana form and can be use in Department Of Revenue Statewide.
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Tags: Merchants Affidavit For Delivery Sales Of Cigarette And Tobacco Products, AFF-1, Indiana Statewide, Department Of Revenue
AFF-1
Indiana Department of Revenue
State Form 51416
(R2/05-07)
Merchant’s Affidavit for Delivery
Sales of Cigarette and Tobacco Products
Merchant Name
Telephone Number
Please mail form to:
Indiana Department of Revenue
P.O. Box 901
Indianapolis, IN 46206-0901
Federal FEIN or SSN
Address
TID (if Applicable)
City
State
Zip Code
Principal Place of Business (if different from above)
List the name(s) and address of each place of business in Indiana
Responsible Officer (Please print)
Date
This affidavit is required to be filed in accordance with IC 24-3-5-6(a) which requires a merchant making a delivery sale of cigarettes
or other tobacco products to notify the Department before making any delivery sale into Indiana.
A delivery sale is defined in IC 24-3-5-1 as: A transaction for the purchase of tobacco products in which an offer to purchase
tobacco products is made:
(1) electronically using a computer network (as defined in IC 35-43-2-3);
(2) by mail; or
(3) by telephone;
and acceptance of the offer results in delivery of tobacco products to a named individual at a designated address.
For questions related to this form call (317) 615-2564 or (317) 615-2561.
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