Loading...
HomeMy WebLinkAboutDub's Liquors (A. Debucas) - 12/31/2020�7 ti Tdwn of Mansfield Town of Mansfield -Boa/^d of fte h1 ° 2019 6 Park Row Mansfield, MA 02048 PERMIT NUMBER: Application for the Sale of Tobacco Products I hereby make application for a permit to sell tobacco products in compliance with the Board of Health Regulation Affecting Smoking and the Sale, Vending and Distribution of Tobacco. By signing this application, I declare that I have read the regulation and am responsible for tobacco product sales regarding federal, state and local laws. This permit expires on December 31st of each year. Violation of this Regulation may result in fines, suspension or revoca ion of this NAMEtOF BUSINESS: A 5-h'n�J e �u C Q S l Ll, LOCATION OF SALE OF TOBACCO PRODUCTS: 30 Cka �� S r' iGtnS�r ? �tl mA 6ZQ�F0 TELEPHONE AT LOCATION: OWNER OF BUSINESS: YY ADDRESS OF OWNER: S TELEPHONE OF OWNER: 308.339.-344 7 O S- -75-Y_ I FAX NUMBER: 50 8--7S S-- $(000 OI -Y If a corporation or partnership, give name, title, and home address of officers or partner. Ar)o SkogJ,2.. CFO I nnCor MA - Briefly describe your tobacco and nicotine delivery product sales training. Attach employee training documentation * Provide a copy of current Department of Revenue CT -3T Retail Excise Unit License. FEE: $150.00 CT -3T NUMBER: 'Jo4� �l8 B�C�areii2� 1�2 88g3�s�, Cc�a,�u ��� FEDERAL ID/SS NUMBER: 4 —i - 't o 9 OZ tF 8 SIGNATURE: DATE: // / S/ Z U/ % PLja3j CLLkSiirN 11guorf-J�0-ebm A check mark signifies your understanding and agreement. I understand and agree that: ❑ It is against the law to sell any tobacco product and/or nicotine delivery product (e.g. e -cigarettes) to anyone less than 21 years of age, regardless of how old the person looks. ❑ Anyone selling tobacco products and/or nicotine delivery products must conclusively establish the customer's age as over 21 years old, by means of government -issued photographic ID. ❑ Anyone selling tobacco products and/or nicotine delivery products must check and verify officia. government photo ID for anyone less than 27 years of age. ❑ I must consent to unannounced, periodic inspections and compliance checks of the permitted retail establishment. ❑ Self-service tobacco product and/or nicotine delivery product displays from which the customer may select products are prohibited. ❑ The sale of single or loose cigarettes or cigarettes in packages of fewer than 20 cigarettes is prohibited. ❑ I may not distribute any free samples of tobacco products or nicotine delivery products (e.g. e -cigarettes) and I may not accept any means, instruments or devices that allow for the redemption of tobacco products for free or cigarettes at a price below the minimum retail price determined by the Massachusetts Department of Revenue. ❑ Tobacco vending machines are prohibited. ❑ Non-residential Roll -Your -Own machines are prohibited. ❑ Blunt wraps are prohibited. ❑ Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days. ❑ 1 may not allow any employee to sell tobacco products or nicotine delivery products (e.g. e -cigarettes) until such employee reads this regulation, state and federal laws regarding the sale of tobacco and signs a statement, a copy of which will be placed on file, that he/she has read the regulation and applicable state laws. ❑ I must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". ❑ I must provide the Board of Health with proof of a current "Cigarette Retailers License" from the Massachusetts Department of Revenue (DOR) and my DOR business permit (Attach a copy of each permit/license). ❑ 1 must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". ❑ I must display signs provided by the Board of Health that discloses referral information about cessation. ❑ If I sell nicotine delivery devices (e.g. e -cigarettes) I must display signs stating that sale of nicotine delivery devices to anyone below the minimum legal sales age is prohibited and that the used of e -cigarettes at indoor establishments is prohibited by local law. I have received, read and understand the Board of Health regulation "Regulation Affecting Smoking and the Sale, Vending, and Distribution of Tobacco and Nicotine Delivery Products" and agree to abide by it. Signature Date Print Name 0.�CJ0 1 t�\ f TAX CERTIFICATION FORM I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under law. Signature of Individual or Corporate Name -7- io90z48 "Social Security No. (Voluntary) or Federal Identification Number X/V By: Corporate Officer (Mandator, if Applicable) *This license will not be issued unless this certification clause is signed by the applicant. ** Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non -filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Massachusetts General Law Chapter 62C, section 49A. C:Wsers\sleite\Desktop\Scott's Documents\Food Establishments- Temp\'PAX CERTIFICATION FORM.doc \ The Commonwealth of Massachusetts U1VDepartment of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 0211 4-2 01 7 www.moss.gov/dia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY, _Applicant Information Please Print Lee[biv Business/Organization Name: �uS1iv.1�►J613uCgs �� 30 CHAvNzy S -r. ELD M4 620V PhoneM Sd2.33 q 3qSY Are ypu an employer? Check the appropriate box: Business Type (required): 1.In I am a employer with employees (full and/ S. ❑ Retail or part-time),* 6. E] Restaurant/Bar/Eating Establishment 2.0 1 am a sole proprietor or partnership and have no ?, E] Office and/or Sales (incl, real estate, auto, etc.) employees working for me in any capacity, $• ❑ Non-profit [No workers' comp, insurance required] 3. ❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c, 152, § 1(4), and we have 10.0 Manufacturing no employees, [No workers' comp, insurance required]* 4. El We are a non-profit orkanization, staffed by volunteers, l l ❑Health Care 6oor Ltii efe,-;wua/ with no employees. [No workers' comp: insurance req.] 12.1@Other 'Any applicant that checks box NI must 0130 611 out the section below showing their workers' compensation policy information, "If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an orgaatmllan should check box N I, I ant an employer that is providbtg worlrers' compensation hrtsttrance for my ettiploycest Belory is the pulley information. Insurance Company Name: MA RETAIL Mf2e34A,y-j�S' (A-te. Crzowf 5yVc, Insurer's Address/: \3080t $5gZ22-gyZ2 City/State/Zip: Q1tA N //l& Mfg 0 2 13S Policy # or Self -ins. Lic. # 0) a 00Y 033232 i 19 Expiration Date: t /1�2-020 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby ceriify der the pahis and penalders ofperjury that the Information provided above is trite and correct. Signature' zDate: // I 9,� 2 / % Official use only. Do not tvrhe ht this area, to be completed by city or town offlelol. City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3, Cityfrown Clerk 4. Licensing Board S. Selectmen's Office 6, Other Contact Person: Phone MASINCO-01 IIHRRAM.1.1 r•,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 11/14/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE THIS DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1S WAIVED, subject to the terms and conditions of the policy, certain pollcles may require an endorsement. A statement on this certificate does not confer ri hts to the certificate holder In lieu of such endorsements . PRODUCER NONTACT First American Insurance Agency PHONE FAX 1A�0,No Ext): (413) 692-8118 IAIc,Nap(413) 592.0995 FAODR PO Box 147 Chicopee, MA 01021 ss: INSURERS AFFORDING COVERAGE NAICN INSURER A; Mass. Retail Merchants WC Gr --- INSURED MAS Inc. INSURERS: INSURER C: DDA Austin Liquors INSURER D: 50 Boston Turnpike iIll'CWSbtlry, MA 01545 INSURER E; INSURER F: Cr1VFRA/9FC THIS IS TO CERTIFY THAT THE POUCn_S OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY ; EOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICAII_ MAY BE ISSUED ORMA'r PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIO':11D CONDITIONS OF SUCI I POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. liEOF INSRACE `�I'L SUBR POLICY EFF,I_p>D WVD POLICY NUMBERLIMITSMI :IALCEN[RAI_ LIABILITY EACH OCCURRENCE § t ,IMS MADE C]OCCUR DAMAGETORENTEO L AGr,Pl 'LATE LIMIT APPLIES PER: POLIO Ow), .1.. _j LOC AUTOMOm. ANY OIAI SCHEDULED AUT( <�ILY AUTOS p AUTOL CaLY AUUTOS ONLY UNIU EI I A I 11,1t ? (I 'CUR EXCESS uY :LAIMS-MADL DFn� 1101.: _ (EI5 C.l"P, 3AlION �- M1 L ✓,uluTY _ 'ROP 11 1 PARTNERIEYECUTIVE YIN 014005033232119 1/112019 111/2020 II i', EXCLUDED, CI 'I I A descn:: RIPUK' i'_ I PFRATION`: dmow DESCRIP'DOl+oc n� in,151 LD,:n 1I ONS I VEHIM S (ACORD 101, Additional Remarks Schedule, may he attached 11 more apaoo In uummad) CERTIFICn,l I- fl; -R Prm I,.I Insurance I-- ACORD ACORD t; (� ,. i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988.2015 ACORD CORPORATION. All rights reserved. the ACORD name and logo are registered marks of ACORD Insurer ID No (s): 34355 MA Retail Merchants WC Group Inc. PO Box 859222-9222 Braintree, MA 02185.0orm Information Pa -lo nem .c named Insured and MAS Inc 56 Boston 1,o ipike Shrewsbury, i',iA 01545 Workers Compensation and Employers Liability Insurance Policy _ Carrier Policy #• _ Policy Period I 014005033232119 01/01/2019 to 01/01/2020 First American Insurance Agency, Inc. 510 Front Street Chicopee, MA 01013 Other Vdnrkpl-" Not ;r„,,wn Abr,ve: See Schedule of Operations Addn ,w;,' if 1 ed; See ;'.dditional Named Insureds if Applicalbe E e of liu s Corp„ k ID mplo/n , nl ' Federal lD#: 273863971 NCCI / Bureau #: 34355 File M 014005033232119 Renewal Item 2. Policy 11, tic ,j 1 i. ,:elicy pen d is from 12:01 AM on 01/01/2019 to 12:01AM on 01/01/2020 based on the insured's mailing -. <.s time z.;ne. Item 3. cove, I,, A. Woi r sol;,,,, ',, ;trance: Part One of the policy applies to the Workers Compensation Law of the states listed: B. LI n"I''O" l,i-,'ilr.e: Part '-woof the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Bodily Injury by Accident $ 500,000.00 each accident Bodily Injury by Disease $ 500,000.00 policy limit C. 0111 r Ir n Bodily Injury by Disease $ 500,000.00 each employee D. Th., o, endorsements and schedules: 308(04 +4), WC000414(07/90), WC0004226(01/16), NOE(01/01), WC200102(01/14), WC200301(04/84), Item 4: I'riu , 503D(0 ./10), WC2003068(06/13), WC200405(06/01), WC200601A(07/O8) ry i-. . The Prem, f, e deter Ined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below IIII I$ s—ubj,=r1 t rit n .rye by 'edit. ' Cede# Premium Basis Rate Per $100 of Estimated Annual Premium Total Estimated Remuneration - Annual Remuneration See Schedule of Operations on Following Pages) Pro,, led Premium Estimated Annual Premium Expense Constant $ ` 5,550.00 $ 5,550.00 D' e $ 0.00 $0.00 Form i; WC 00 n i r, Countersigned by: ��� - (Ed. ) "`."`'"� en1q ,.,,oncm,nn ,acurannu inn All Rinhra P—onied Conunonwealnt of Mossachusetts Deparhncnt ur Rcvcnuc Chrislo her C. Hardin ., Lcucr ID: L0095576704 •r t�r� �al' P b Commissioner Noticc Date: September 4, 2018 "mss.gov/dor Accoumtt to: CCL -12086867-005 RETAILER LICENSE FOR SALE OF CIGARETTES AUSTIN DEBUCAS LLC DUBS'S LIQUORS & FINE WINES 8 50 BOSTON TURNPIKE ROAD o SHREWSBURYMA 01545-3914 Attached below is your Retailer License for Sale of Cigarettes (Form CT -3T). Cut along the dotted line and display at your business location, At any time, you can log into your MassTaxCon mass.gov/hnasstaxconncct to view and re -print a copy of this license. nect account at If you have any questions about your license, call us at (617) 887-6367 or toll-free in Massachusetts at (800) 392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. ------------------------------------DETACH HERE -------------------------------------------- - "� MASSACHUSETTS DEPARTMENT OF REVENUE 1 Retailer License for Sale of Cigarettes Form CT -3T y FMrora'� This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. AUSTIN DEBUCAS LLC DUBS'S LIQUORS & FINE WINES Account ID: CGL -12086867-005 30 CHAUNCY ST License Number: 3647488 MANSFIELD MA 02048-1958 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts Genera( Laws to sell r ro col t the address shown above. This license is non -transferable and may be suspended or revoked fa failure to comply with state laws and regulations. Effective Date: October 1, 2018 Expiration Date: September 30, 2020 o� o�4 �.45nta„t^rFjA Com utonwealth of Massachusetts Dcparhncnlot'Rcvcnoc Letter ID: L0475415168 �`,0' Christopher C. Harding, Commissioner a. Notice Date: Scptcmbcr4, 2018 O,; . nmss.gov/dor Account ID: CRL -12086867-008 rF�T usa RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO AUSTIN DCBUCAS LLC NDUBS'S LIQUORS & F1NG WINES 0 50 BOSTON TURNPIKE ROAD SHREWSBURY MA 01545-3914 Attached below is your Retailer License for Sale of Cigars and Smoking Tobacco (Form CT -3T Cut along the dotted line and display at your business location. At any time, you can log into your MassTaxConuect account at mass.gov/masstaxconnect to view and re -prima copy of flus license, If you have any questions about your license, call us at (617) 887-6367 or toll-free in Massachusetts at (800) 392-6089, Monday through Friday, 8:30 a.m. to 4:30 p.m. DETACH HERE qA ip --------------------------------- sP” MASSACHUSETTS DEPARTMENT OF REVENUE O *O)y y Retailer License for Sale of Cigars and Smoking Tobacco Form CT -3T y u� FNr oY" This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. AUSTIN DEBUCAS LLC DUBS'S LIQUORS & FINE WINES Account ID: CRL -12086867-008 30 CHAUNCY ST License Number: 1428883456 MANSFIELD MA 02048.1958 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts Gen failure to comply with state laws and regulations. ses eral Laws to sell retail at the address shown above. This liceninon-transferable and may be suspended or revoked for Effective Date: October 1, 2018 Expiration Date: September 30, 2020 Training Procedure and Enforcement All employees are required to read and sign the attached Policy & Procedures literature. All employees are required to ask for valid ID for anyone appearing under the age of 30. Acceptable forms of ID are a valid MA State drivers license or MA State issued ID card, a valid passport, a valid military ID or a valid out of state drivers license if it passes our ID Checker. All expiration dates are checked. New employees are closely monitored for compliance by management. i e Smith, Manager Date Austin Debucas LLC 30 Chauncy St Mansfield, MA 012048 A check mark signifies your understanding and agreement. l understand and agree that: R It is against the law to sell any tobacco product and/or nicotine dellvery product (e.g. e -cigarettes) to anyone less than 21 years of age, regardless of how old the person looks. /Anyone Anyone selling tobacco products and/or nicotine delivery products must conclusively establish the customer's age as over 21 years old, by means of government -Issued photographic 1D. ,0' Anyone selling tobacco products and/or nicotine delivery products must check and verify officio'. government photo ID for anyone less than 27 years of age. (� I must consent to unannounced, periodic Inspections and compliance checks of the permitted retail establishment. E( Self-service tobacco product and/or nicotine delivery product displays from which the customer may select products are prohibited. da/ The sale of single or loose cigarettes orcigarettes In packages of fewer than 20 cigarettes is prohibited. 0' 1 may not distribute any free samples of tobacco products or nicotine delivery products (e.g. e -cigarettes) and I may not accept any means, Instruments or devices that allow for the redemption of tobacco products for free or cigarettes at a price below the minimum retail price determined by the Massachusetts Department of Revenue, a Tobacco vending machines are prohibited. Z/ Non-residential Roll -Your -Own machines are prohibited. Blunt wraps are prohibited. Penalties for violation of the regulation Include monetary fines and/or suspension of this permit for seven or thirty days. p' I may not allow any employee to sell tobacco products or nicotine delivery products (e.g. e-dgarettes) until such employee reads this regulation, state and federal laws regarding the sale of tobacco and signs a statement, a copy of which will be placed on file, that he/she has read the regulation and applicable state laws. 2( 1 must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". 0/I must provide the Board of Health with proof of a current "Cigarette Retailers License" from the Massachusetts /Department of Revenue (DOR) and my DOR business permit (Attach a copy of each permit/ilcense)l/ ❑I must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". fd/I must display signs provided by the Board of Health that discloses referral information about cessation. f3"/ If I sell nicotine delivery devices (e.g. e -cigarettes) I must display signs stating that sale of nicotine delivery devices to anyone below the minimum legal sales age Is prohibited and that the used of e -cigarettes at Indoor establishments is prohibited by local law. I have received, read and understand the Board of Health regulation "Regulation Affecting Smoking and the Sale, Vending, and Distribution of Tobacco and Nicotine Delivery Products" and agree to abide by it. Signature -� Date— Print Name � G��M t 1 ° \ K Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted items to ensure these Items do not get sold to minorsl TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, roiling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of Id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If It 1s suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that If I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bids.:, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. If any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permisslon to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my judgment not to make the sale in any of the cases described above. Failure" Is policy1may##lt in disciplinary action up to and including termination. Employee si ature Date Store3Spe4toP ute t L�Date This form will be maintained in your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsiblilty to control the sale and distribution of age -restricted Items to ensure these Items do not get sold to minors) TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if It passes our 10 Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it is suspected that someone is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fail to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: 1 will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. If any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, i will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my Judgment not to make the sale in any of the cases described above. Failure to follow this policy may result in disciplinary action up to and Including termination. Cv' Employee signature Store perator sJgna u a t._.— Date I IL � Date This form will be maintained In your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted Items to ensure these Items do not get sold to minors) TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It Is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUOURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state Issued Id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If It is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support myjudgment not to make the sale in any of the cases described above. Failure to follow this policy may result in disciplinary action up to and including termina6m, ployee si ture pate Stare pe1ato uf"e jl 11,I�� Date � This form will be maintained in your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted items to ensure these Items do not get sold to minors) TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, roiling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21)• PROCUDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of Identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if it passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If It is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, Including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my judgment not to make the sale In any of the cases described above. Failure to follow this policy may result in disciplinary action up to and including termination. Employee signature Stare Lip o� § 1g aUFe Dat)c jcr 4 — --- Date This form will be maintained in your personnel file as a part of your permanent employee record, C"' "Q ;', '� :; --, Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02M Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted Items to ensure these Items do not get sold to minorsi TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e•cigarettes, vape and lighters. The minimum age to purchase tobacco products Is twenty one (21) years of age, It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if it passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. if it is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my judgment not to make the sale in any of the cases described above. Failure to follow this policy may result in disciplinary action up to and Including termination. Employee signature Storewefato—rs etu% i f Date ll 15 Ili_ Date This form will be maintained in your personnel fife as a pan of your permanent employee record. '�;ffv," r) Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted items to ensure these Items do not get sold to minors] TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, roiling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21), PROCUDURES: 1. This policy will be reviewed with all new Employees before they can operate a cath register and sell tobacco products. 2. A valid form of Identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bldis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my judgment not to make the sale In any of the Lases described above. Failure to follow this policy may result in disciplinary action up to and including termination. 2p" Stare- �pefator � uFe Date 41-C a Date This form will be maintained in your personnel flee as a part of your permanent employee record, x' ,-) - SCA Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted Items to ensure these Items do not get sold to minorsi TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this polity related to the sale of tobacco products Including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age, It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: 1. This policy will be reviewed with all new Employees before they can operate a rash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state Issued id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the, sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fail to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my judgment not to make the sale In any of the gases described above, Failure to follow this policy may result in disciplinary action up to and including termination. E yee Lsignature Date 41 Store pefato��Fe `" Date j This form will be maintained in your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted Items to ensure these Items do not get sold to minorsl TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21), PROCUDURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of state License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that If I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, Who;, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my Judgment not to make the sale In any of the cases described above. Stu ieOpe6ioe Ognetufe disciplinary action up to and including termination. (—I5�— (9 Date Date I This form will be maintained in your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age restricted items to ensure these Items do not get sold to minors) TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products Including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e•cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It Is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If It is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fail to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bldis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my Judgment not to make the sale in any of the cases described above. Failure to follow this policy may result in disciplinary action up to and including termination. Em oyeekignature Date f _ Stare perat-0 jg ufe Date This form will be maintained in your personnel file as a part of your permanent employee record, Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted items to ensure these Items do not get sold to minors) TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e•cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It Is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if it passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the parry. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if 1 fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my Judgment not to make the sale in any of the eases described above. Failure to follow this policy may result in disciplinary action up to and Including terminatian. r Store. per to�*Rufe Date Date This form will be maintained in your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfield, MA WAS Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted items to ensure these Items do not get sold to minors] TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products, 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state Issued Id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If It is suspected that someone is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fail to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bldis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. If any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my Judgment not to make the sale in any of the cases described above. Failure to follow this policy may result in disciplinary action up to and including termination. Employee signature Stare6Peratof gnetbte Date Y Date ; This form will be maintained In your personnel fife as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the side and distribution of age -restricted items to ensure these Items do not get sold to minors] TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: 1. This polity will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of Identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued id Valid US passport Valid Out of State License If It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if i fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21. if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my judgment not to make the sale in any of the cases described above. Failure to follow this policy may result in disciplinary action up to and including terminathm. Empl yee signature Store Oper%for s an ut-1 �^ Date s. C Date =�— This form will be maintained in your personnel file as a part of your permanent employee record. I,-) -3 e-\ Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted Items to ensure these Items do not get sold to minorsl TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it Is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that If I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support myjudgment not to make the sale in any of the cases described above. Failure to follow this policy may result in/dj;ciplinery action up to and including termination. Employee signsif4i y� Date StoreOperatorratuFe Date This form will be maintained in your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted items to ensure these Items do not get sold to minorsl TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products Including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (21) years of age. It Is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of Identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If It is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, i could lose my job or be fined. ,prom Woldwo luauewiad moA;o Sued a se aig lauuosiad jnoA ul paulelulew aq pim wo; s141 alep a15 olejad aojS aanleuS s eaAoldw3 •uolleulwial Sulpnpul pue of do uolpe Aieulldlaslp ul llnsaa Aew Aollod slyi mollo; of ajnpe3 •anoge pagljasep sasea ai l;o Aue ul ales agl alew o; lou luawvpn(Aw uoddns of seeige luawalleueW luin3 ul •slonpad ooaegol Anq of TZ 10 ave aql japun uosaad e of uolsslwiad SuIAIS llnpe ue woj; alou a ldaaae lou Illm I -ales ay; a:lew lou IAm I 'pulse uaym al ;o wo; olgeltlaaae ue aplAad of algeun sl pug aseyaind oaaegol a a:lew of sldwoue ave ;o sselpievai uosaad Aue;I •tZ;o ave ayl japun uosiad Aue of lanpoid Aaanllop oulloolu Aue io'ooaegol;o waoj Jaylo hue Jo'siplq'oaaegol Sulmayo'siellp'sauaievla Sulpnpul 'slanpoid o»egos Aue Iles lou plm I :slonpo.id oaoegol;o ales ayi lnoge solni vuimopo; 044 of agile I Age Restricted Products Policy and Procedures: Tobacco Austin Debucas LLC, 30 Chauncy Street, Mansfleld, MA 02CAS Every Employee at this location has the LEGAL and MORAL responsibility to control the stale and distribution of age restricted items to ensure these Items do not get sold to minors TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products Is twenty one (21) years of age. It Is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUOURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of Id are as follows: Valid Massachusetts License Valid Massachusetts state issued Id Valid US passport Valid Out of State License if It passes our ID Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If It is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. 1 also understand that if I fail to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, Including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, if any person regardless of age attempts to make a tobacco purchase and is unable to provide an acceptable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving perrolssion to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my judgment not to make the sale in any of the cases described above. Failure to follow this policy may result in disciplinary action up to and including termination, 4MP10yee4signatur Store. er5to� Jgnew Date Date This form will be maintained in your personnel file as a part of your permanent employee record. Age Restricted Products Policy and Procedures: Tobacco Austin Debucas I.I.C. 30 Chauncy Street, Mansfield, MA 02048 Every Employee at this location has the LEGAL and MORAL responsibility to control the sale and distribution of age -restricted items to ensure these Items do not get sold to minors) TOBACCO PRODUCT SALES POLICY Objective: That all store Employees follow all laws and procedures of this policy related to the sale of tobacco products including: cigarettes, smokeless tobacco, loose tobacco, pipe tobacco, rolling papers, cigars, e -cigarettes, vape and lighters. The minimum age to purchase tobacco products is twenty one (2 1) years of age. It is our responsibility as a retailer and members of the community to prevent the sale of tobacco to anyone under the age of twenty one (21). PROCUDURES: I. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. A valid form of identification will be required for all tobacco purchases regardless of age or frequency of customer visits. Acceptable forms of id are as follows: Valid Massachusetts License Valid Massachusetts state issued id Valid US passport Valid Out of State License if It passes our 10 Checker NO EXPIRED IDENTIFICATIONS WILL BE ACCEPTED 3. Photos must be visually matched to the purchaser. 4. If it is suspected that someone Is purchasing tobacco for anyone under the age of twenty-one (21) a valid ID will be required from all members of the party. I have read and understand the Mansfield Board of Health Regulations which prohibits the sale of tobacco and nicotine delivery products to anyone under the age of 21. I also understand that if I fall to follow store policy and local and state laws about the sale of tabacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. I agree to the following rules about the sale of tobacco products: I will not sell any tobacco products, including cigarettes, cigars, chewing tobacco, bidis, or any other form of tobacco, or any nicotine delivery product to any person under the age of 21, If any person regardless of age attempts to make a tobacco purchase and is unable to provide an accelitable form of ID when asked, I will not make the sale. I will not accept a note from an adult giving permission to a person under the age of 21 to buy tobacco products. In turn, Management agrees to support my Judgment not to make the sale in any of the eases described above. may result in disciplinary action up to and Including termination. StorOopeldto" Date Date b This form will be maintained in your personnel file as a part of your permanent employee record.