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HomeMy WebLinkAboutSunoco 40082H - 12/31/2020too�I� Town of Mansfield e ivrrloU ansfield - Board of Health 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 revocation of this permit. � ' A NAME OF BUSINESS: J vvY� C) 0,0 LOCATION OF SALE OF TOBACCO PRODUCTS: TELEPHONE AT LOCATION: OWNER OF BUSINESS: ADDRESS OF OWNER: TELEPHONE OF OWNER: ago FAX NUMBER: cA �Z ___I 3—f- If a corporation or partnership, give name, title, and home address of officers or partner. Briefly describe your tobacco and nicotine delivery product sales training. Attach employee training * Provide a copy ofcurrentpeparttment of Revenue CT-3T Retail Excise Unit License. FEE: $150.00 CT-3T NUMBER: FEDERAL ID/SS NUMBER: SIGNATURE: DATE: -Z( .S STATE OFIM.I LIST OF OFFICERS Joseph M DePinto Pres/CEO Rankin Gasaway SVP/GC,/SEC David Seltzer VP/TR Commonwealth of Mamachuseaa Depanmcm of Revenue Christopher C. Harding, Commissioner mms.gov/dor IAnoND: 1,I661420800 Notiu Date: September N, 2018 Account to: C01,10196336.110 RETAILER LICENSE FOR SALE OF CIGARETTES IIII gtoll llpr11411�rp14tllP 1111111111dnhl1hd1111111111 7ELEVENINC 7-ELEVEN 31445H PO BOX 711 DALLAS TX 75221.0711 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 MossTaxConnect account at mass.gov/masstaxconnect to view and re -print a copy of this 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 0 ,4✓'eH�sFj� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T P Retailer License for Sale of Cigarettes R e� ot� This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. 7 ELEVEN INC Account ID: COL-10196336-110 SUNOCO #40082H Location ID: 10196336-0704 70 COPELAND DR License Number: 222687232 MANSFIELD MA 02048-1221 This certifies that the taxpayer named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above. This license is non -transferable and may be suspended or revoked for failure to comply with state laws and regulations. Effective Date: October 1, 2018 Expiration Date: September 30, 2020 ,g✓�rttps, Camnoawallb of MauuMulats Letter ID: L2011095690 Y p'J Departmrnt of Revenue Notice Date: September 20,2018 Christopher C. Harding, Commissioner Account to: CRL-10196336-113 'yE1v7 M� mass.gov/dor RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO Irllnlhrhtihtbdlh411r4rtpptll^I4tl14t49hdllwl 7 ELEVEN INC 7-ELEVEN """^- PO BOX 711 DALLAS TX 75221-0711 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 MassTaxConnect account at moss.gov/masstaxconnect to view and re -print a copy of this 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 MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T o Retailer License for Sale of Cigars and Smoking Tobacco ^1f�,n. ppa This license must be posted and visible at all times. The sale of tobacco products to anyone under 18 years of age is prohibited. 7 ELEVEN INC Account ID: CRL-10196336-113 SUNOCO N40082H Location ID: 10196336-0705 70 COPELAND DR License Number: 730755072 MANSFIELD MA 02048.1221 This certifies that the taxpayer- named above is licensed under Chapter 64C of the Massachusetts General Laws to sell at retail at the address shown above, This license is non -transferable and may be suspended or revoked for failure to comply with state laws and regulations, Effective Date: October 1, 2018 Expiration Date: September 30, 2020 Age -Restricted Products Policy & Procedures: Tobacco LOCATION Store 6035 - 40082 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 III 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). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. 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 id Valid US passport Valid Out of State License No expired identification will be accepted. Photos must be visually matched to the customer purchasing and licenses scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 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 twenty-one (21) years. I also understand that If I fail to follow store policy and local and state laws about the sale of tobacco 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 without an acceptable, 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. mployee Signature Store Operator Signature Date Date (This form will be maintained in your personnel file as a part of your permanent employee record) A check mark signifies your understanding and agreement. I understand and agree that: Csi 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. I/ Anyone selling tobacco products and/or nicotine delivery products must conclusively establish the customers age as over 21 years old, by means of government -issued photographic ID. F/ Anyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. C� I must consent to unannounced, periodic inspections and compliance checks of the permitted retail establishment. 2i Self-service tobacco product and/or nicotine delivery product displays from which the customer may select / products are prohibited. I3 The sale of single or loose cigarettes or cigarettes In packages of fewer than 20 cigarettes is prohibited. Ei 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. CY Tobacco vending machines are prohibited. Non-residential Roll -Your -Own machines are prohibited. M Blunt wraps are prohibited. CJ Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days. 6 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. fJf I must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". C� 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). C1 I must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". 9/1 must display signs provided by the Board of Health that discloses referral information about cessation. pi/ 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 x�1 Date Print Name J LO f,=19J4 '/S,//Z/(AvJ�r/ Age -Restricted Products Policy & Procedures: Tobacco LOCATION Store 6035 - 40082 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). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. 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 id Valid US passport Valid Out of State License No expired identification will be accepted. Photos must be visually matched to the customer purchasing and licenses scanned into the register. Driver's license is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 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 twenty-one (21) years. I also understand that If I fail to follow store policy and local and state laws about the sale of tobacco 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 persomunder the age of 21. If any person regardless of age attempts to make a tobacco purchase without an acceptable, 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 te, motion. Employee Signature Store Operator Signature Z-0 Date Date (This form will be maintained in your personnel file as a part of your permanent employee record) A check mark signifies your understanding and agreement. i understand and agree that: 0 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. 0 Anyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. 0 1 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. 0 The sale of single or loose cigarettes or cigarettes in packages of fewer than 20 cigarettes is prohibited. 0 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. 0 Non-residential Roll -Your -Own machines are prohibited. ❑ Blunt wraps are prohibited. 0 Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days. 0 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". ❑ 1 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". 0 1 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 z Date /G fi2� g C Ol `7 Print Name Age -Restricted Products Policy & Procedures: Tobacco LOCATION Store 6035 - 40082 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!1 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). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. 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 id Valid US passport Valid Out of State License No expired identification will be accepted. Photos must be visually matched to the customer purchasing and licenses scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 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 twenty-one (21) years. I also understand that if I fail to follow store policy and local and state laws about the sale of tobacco 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 without an acceptable, 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. Wes,►..4 Employee Store Operator Signature Date Date (This form will be maintained in your personnel file as a part of your permanent employee record) A check mark signifies your understanding and agreement. I understand and agree that: I(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. iAnyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. 1 must consent to unannounced, periodic inspections and compliance checks of the permitted retail establishment. W Self-service tobacco product and/or nicotine delivery product displays from which the customer may select pTroducts are prohibited. ��W��W//// he 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 iay 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. I 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). (11must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". must display signs provided by the Board of Health that discloses referral information about cessation. CW 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 if tyuJ/k?q� Date l 1/0D 1 L6lq V61 I'll Print Name %)1 1G%t G,`( r Age -Restricted Products Policy & Procedures: Tobacco LOCATION Store 6035 - 40082 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). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. 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 id Valid US passport Valid Out of State License No expired identification will be accepted. Photos must be visually matched to the customer purchasing and licenses scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 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 twenty-one (21) years. I also understand that if I fail to follow store policy and local and state laws about the sale of tobacco 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 without an acceptable, 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 termina Employee Signature Date Store Operator Signature Date (This form will be maintained in your personnel file as a part of your permanent employee record) A check mark signifies your understanding and agreement. I understand and agree that: 11— 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. W/ 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. Cr Anyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. If 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. If' 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. Ci Non-residential Roll -Your -Own machines are prohibited. 4r Blunt wraps are prohibited. D Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days. 0- 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. 9 1 must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". Ot 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). 0 I must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". 11� i must display signs provided by the Board of Health that discloses referral information about cessation. Ci 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. Date � ( ` 1 , Z (r Print Name1 M Age -Restricted Products Policy & Procedures: Tobacco LOCATION Store 6035 - 40082 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). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. 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 id Valid US passport Valid Out of State License No expired identification will be accepted. Photos must be visually matched to the customer purchasing and licenses scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 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 twenty-one (21) years. I also understand that If i fail to follow store policy and local and state laws about the sale of tobacco 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 without an acceptable, 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 loyee Signature " Store Operator Signature Date /-F-/f Date (This form will be maintained in your personnel file as a part of your permanent employee record) A check mark signifies your understanding and agreement. I understand and agree that: d 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. M/ 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. C'/ Anyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. GK I must consent to unannounced, periodic inspections and compliance checks of the permitted retail establishment. ly/ Self-service tobacco product and/or nicotine delivery product displays from which the customer may select products are prohibited. 0/The sale of single or loose cigarettes or cigarettes In packages of fewer than 20 cigarettes is prohibited. EJ 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. 0 Tobacco vending machines are prohibited. I9 Non-residential Roll -Your -Own machines are prohibited. lu Blunt wraps are prohibited. W Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days, fit/ 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. P1/ I must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices", U 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). 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. [0 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 T^ Date 1 i � I Print Name C _}^ Lt t I )at I L( C'(Z I C Age -Restricted Products Policy & Procedures: Tobacco LOCATION Store 6035 - 40082 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). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. 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 id Valid US passport Valid Out of State License No expired identification will be accepted. Photos must be visually matched to the customer purchasing and licenses scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 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 twenty-one (21) years. I also understand that If I fail to follow store policy and local and state laws about the sale of tobacco or nicotine delivery products to any person under the legal age, I could lose my job or be fined. 1 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 dellvery product to any person under the age of 21. If any person regardless of age attempts to make a tobacco purchase without an acceptable, 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. 1 z17z/_Y Employee Signature Store Operator Signature Date r, 17 l� s Date (This form will be maintained in your personnel file as a part of your permanent employee record) A check mark signifies your understanding and agreement. I understand and agree that: /P( 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. 6Anyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. r�Y I/must consent to unannounced, periodic inspections and compliance checks of the permitted retail 'stablishment. Self-service tobacco product and/or nicotine delivery product displays from which the customer may select ,,,Products are prohibited. LThe sale of single or loose cigarettes or cigarettes In packages of fewer than 20 cigarettes is prohibited. ❑]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 / 4ccJgarettes at a price below the minimum retail price determined by the Massachusetts Department of Revenue. j 6cco vending machines are prohibited. N n-residential Roll -Your -Own machines are prohibited. Blu t wraps are prohibited. Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thi ,'days. I 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 rj JC�py of which will be placed on file, that he/she has read the regulation and applicable state laws. I mu prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". rn ust provide the Board of Health with proof of a current "Cigarette Retailers License" from the Massachusetts artment of Revenue (DOR) and my DOR business permit (Attach a copy of each permit/license). �,tmpust display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". (�must display signs provided by the Board of Health that discloses referral information about cessation. off 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 1� "1 Print Name /� C Vy Age -Restricted Products Policy & Procedures: Tobacco LOCATION Store 6035 - 40082 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). PROCEDURES: 1. This policy will be reviewed with all new Employees before they can operate a cash register and sell tobacco products. 2. All store Employees to take computer based training and successfully pass with 100% prior to starting on a register. This certification to be updated on an annual basis prior to previous year expiration. 3. 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 id Valid US passport Valid Out of State License No expired identification will be accepted. Photos must be visually matched to the customer purchasing and licenses scanned into the register. Driver's License is to be scanned into the register system. All other identification from the acceptable list will require manual entry of the date of birth listed on the documentation. 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 twenty-one (21) years. I also understand that If I fail to follow store policy and local and state laws about the sale of tobacco 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 without an acceptable, 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 ignature Store Operator Signature II�$�1q Date Date (This form will be maintained in your personnel file as a part of your permanent employee record) 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-clgarettes) 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. 3 Anyone selling tobacco products and/or nicotine delivery products must check and verify official government photo ID for anyone less than 27 years of age. Gd� I must consent to unannounced, periodic inspections and compliance checks of the permitted retail establishment. C✓ Self-service tobacco product and/or nicotine delivery product displays from which the customer may select products are prohibited. t� 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. d Tobacco vending machines are prohibited. El Non-residential Roll -Your -Own machines are prohibited. C�(/ Blunt wraps are prohibited. D Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days. If I 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. Q/ I must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". F1( 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), e( I must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". IJ I must display signs provided by the Board of Health that discloses referral information about cessation. Li 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 Oxisto IAAt (