County of Sonoma TRL Application 2022-2023

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.

Payment: The Fee is $350.00. Due by July 1 2022.

We are currently accepting credit card or checks. Please mail check to: 625 5th Street, Santa Rosa CA 95404. ATTN: Impact Sonoma, Tobacco Prevention Program.
Select payment method:

check (enter check number and date mailed below). electronic payment (enter information below under Electronic Payment)
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Month Day Year
Date

Electronic Payment

Tobacco Retailer License - Unincorporated Sonoma County 2022-2023

$ 350.00

Total

$ 0.00

2022-2023 Tobacco Retail License Application: County of Sonoma Unincorporated