Do I need a notary for the tobacco permit application?

No. The application calls for a signature and date from the owner, operator, or corporation officer; it does not specify a notarized attachment.

How do I submit the tobacco permit application?

Complete and sign it, include the fee and required documents, and return it to the Dutchess County Department of Behavioral & Community Health at the address on the form.

What documents must accompany the application?

Include one listed workers’ compensation document, one listed disability benefits document, and a copy of the NYS Retail Dealer Certificate of Registration.

When should I submit a renewal?

The form says to submit a renewal at least 30 days before the permit expires, or 15 days before tobacco product sales begin.

Dutchess County, NY · Dutchess County

No notary required

Application for Permit to Sell or Distribute Tobacco Products

Dutchess County businesses use this application to request or renew a permit to sell or distribute tobacco products at a facility.

At a glance

Issued by: City of Dutchess County · Dutchess County, Dutchess County, New York
Notarization: Not required: file this form without a notary.
Official source: dutchessny.gov
Blank form: Download the PDF
Catalogued: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This application requests a new or renewed Dutchess County permit to sell or distribute tobacco products. Applicants provide business, facility, and owner or operator information, certify their understanding of applicable requirements, and include workers’ compensation and disability documentation. The form says renewals must be submitted at least 30 days before expiration, or 15 days before tobacco product sales begin.

Who needs it

A business owner or operator seeking a new or renewed Dutchess County permit to sell or distribute tobacco products must complete this application.

How to submit it

Complete, sign, and return the application with the fee to the Dutchess County Department of Behavioral & Community Health, Attention: Environmental Health / Tobacco, 85 Civic Center Plaza, Suite 106, Poughkeepsie, NY 12601. Include the required insurance documents and a copy of the NYS Retail Dealer Certificate of Registration.

About notarization

This application is signed and dated without a notary; the owner, operator, or corporation officer signs the certification, and no notarized attachment is specified.

How to submit this form

1
Download the Application
Download the Dutchess County application for a new tobacco permit or renewal.
2
Complete and Sign
Fill in all fields and have the owner, operator, or corporation officer sign and date the certification.
3
Gather Required Documents
Include the required workers’ compensation and disability documentation, a copy of the NYS Retail Dealer Certificate of Registration, and the fee.
4
Submit to the County
Return the completed application and materials to the county department at the address provided on the form.

Frequently asked questions

Do I need a notary for the tobacco permit application?: No. The application calls for a signature and date from the owner, operator, or corporation officer; it does not specify a notarized attachment.
How do I submit the tobacco permit application?: Complete and sign it, include the fee and required documents, and return it to the Dutchess County Department of Behavioral & Community Health at the address on the form.
What documents must accompany the application?: Include one listed workers’ compensation document, one listed disability benefits document, and a copy of the NYS Retail Dealer Certificate of Registration.
When should I submit a renewal?: The form says to submit a renewal at least 30 days before the permit expires, or 15 days before tobacco product sales begin.

Need something notarized?

This Application for Permit to Sell or Distribute Tobacco Products doesn’t need a notary, but if you have another Dutchess County form that does, a commissioned online notary can help.