2022-2023 Tobacco Retail License (TRL) Application: City of Petaluma
To apply for a City of Petaluma tobacco retail license, please complete this application. Instructions on how to pay the license fee of $525 are at the end of this application form. All applications are first reviewed to check for eligibility. Only retailers who meet the following criteria are eligible: 1. were already licensed, and are current with, their California Department of Tax & Fee Administration (CDTFA) license to sell tobacco when the City's ordinance was adopted (Jan. 7 2022), 2. have a business license issued by the City of Petaluma, 3. are in good standing with the City of Petaluma.
Name of person completing this form
First Name
Last Name
Name of business
Business address (physical address where the business is located)
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Business phone number for physical address (10 digits)
Please enter a valid phone number.
Is this a cell phone that can receive text messages?
yes
no, this is a land line
As another way to communicate with you we may send a text. In order to send a text from our email system, please indicate your cell phone carrier.
Verizon
AT&T
Sprint
T-Mobile
Other
Business email
example@example.com
California State Department of Tax and Fee Administration (CDTFA) Tobacco Retailer License/Permit #
CDTFA Tobacco Retailer License/Permit expiration date
-
Month
-
Day
Year
Date
Does the store sell alcohol?
Yes
No
Alcoholic Beverage Control (ABC) license number
ABC license expiration date
-
Month
-
Day
Year
Date
Does the store work with a tobacco distributor?
Yes
No
Name of tobacco distributor
Phone number of tobacco distributor
Please enter a valid phone number.
Email address of tobacco distributor
example@example.com
Type of Business
Sole Proprietorship
Partnership
LLC or Corporation
For Sole Proprietorship or Partnership: How many owners are there?
1
2
3
4 or more
For Sole Proprietorship or Partnership: Owner #1 Contact Information (for multiple owners you can enter information below). Please list owner #1 as the primary contact for the business.
First Name
Last Name
Owner #1 phone number
Please enter a valid phone number.
Owner #1 contact information email
example@example.com
Owner #1 address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
For Sole Proprietorship or Partnership: Owner #2 contact information
First Name
Last Name
Owner #2 phone number
Please enter a valid phone number.
Owner #2 email
example@example.com
Owner #2 address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Back
Next
For LLC or corporation: name of corporation
Corporate representative contact information
First Name
Last Name
Corporate representative email
example@example.com
Corporate address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Back
Next
Primary contact on-site at retail location
First Name
Last Name
Title
Phone number
Please enter a valid phone number.
Is this a cell phone that can receive a text message?
Yes
No
As another way to communicate with you we may send a text. In order to send a text from our email system, we need to know your cell phone carrier?
Verizon
AT&T
Sprint
T-Mobile
Other
Email
example@example.com
Secondary contact on location
First Name
Last Name
Secondary contact title
Secondary contact phone number
Please enter a valid phone number.
Is this a cell phone that can receive a text message?
Yes
No
As another way to communicate with you we may send a text. In order to send a text from our email system, we need to know your cell phone carrier?
Verizon
AT&T
Sprint
T-Mobile
Other
Secondary contact email
example@example.com
Back
Next
Responsible parties— representative owner or the corporate representative—must acknowledge reading the following four statements
1. I/we are informed of the laws pertaining to selling tobacco, and shall ensure that all employees and retail associates are also informed.
*
I/We acknowledge reading this statement.
2. I/we declare under penalty of perjury that all of the information provided in this application is true, complete and accurate. Any false or dishonest answer to any questions may be grounds for denial or subsequent revocation of the certificate, license, or permit.
*
I/We acknowledge reading this statement.
3. I/we shall inform the Department of Health Services, in writing, of any change in the information submitted within ten (10) business days of a change.
*
I/We acknowledge reading this statement.
4. I/we understand that information in this application may be considered public, and subject to disclosure under the California Public Records Act (California Government Code §6250 et seq.) or any other applicable law.
*
I/We acknowledge reading this statement.
Back
Next
Payment: The Fee is $525.00. Due by July 6 2022.
You may pay by credit card, or regular check payable to "County of Sonoma Department of Health Services" (mail to 625 5th Street, Santa Rosa, CA 95404). If paying by credit card, proceed to the payment information below.
Check
Credit Card
prev
next
( X )
City of Petaluma - Tobacco Retailer License (TRL) $525
$
525.00
Credit Card
First Name
Last Name
Credit Card Number
Security Code
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
Expiration Year
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Submit
Should be Empty: