Cayuga County, NY · Cayuga County
Application for a Tobacco Retail License
Cayuga County tobacco retailers use this application to request a license by providing business, facility, and responsible-party information.
At a glance
- Issued by
- City of Cayuga County · Cayuga County, Cayuga County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- cayugacounty.us
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This application is for a business seeking a Cayuga County tobacco retail license. It asks for the retail name and address, contact details, responsible-party information, facility type, tax certificate status, and answers about prior license revocation and outstanding county charges. The form lists a $100 fee and requires the responsible party or owner to sign and date the certification.
Who needs it
A tobacco retailer seeking a Cayuga County license should complete the application and provide the requested business and responsible-party information.
How to submit it
Submit the completed application and the listed $100 fee to the Cayuga County Health Department, 8 Dill Street, Auburn, NY 13021.
About notarization
This document is signed without a notary; the responsible party or owner signs and dates the application.
How to submit this form
- 1
Download the Application
Download the tobacco retail license application.
- 2
Complete the Application
Fill in all requested application and facility information.
- 3
Sign and Date
The responsible party or owner signs and dates the certification.
- 4
Submit to the County
Submit the application and listed $100 fee to the Cayuga County Health Department at 8 Dill Street, Auburn, NY 13021.
Frequently asked questions
- Do I need a notary for the tobacco retail license application?
- No. The responsible party or owner signs and dates the application; it does not call for notarization.
- How do I submit the tobacco retail license application?
- Submit the completed application and the listed $100 fee to the Cayuga County Health Department at 8 Dill Street, Auburn, NY 13021.
- What information does the application ask for?
- It requests retail and owner details, facility type, tax certificate information, and answers about prior license revocation and outstanding county charges.