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Home My WebLink AboutCumberland Farms #0187 - 12/31/2020I Town of Mansfield Town of Mansfield - Board of Health 6 Park Row Mansfield, MA 02048 U4cikSIYi1I1Lh1 14tA 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. NAME OF BUSINESS: LOCATION OF SALE OF TOBACCO PRODUCTS: 3O GhaUncy 5r, TELEPHONE AT LOCATION: j08- AG/ _ 75�5 7 OWNER OF BUSINESS: ADDRESS OF OWNER: TELEPHONE OF OWNER: FAX NUMBER: a'/07 If a corporation or partnership, give name, title, and home address of officers or partne,(.'I tyTaher1 nc4 Farms, Inc. Flanders I"; Briefly describe your tobacco and nicotine delivery product sales training. documentation /9__ L/V ;i__y �.�, . /,'—_ . n e'"/7/ours_ /I'iugy- View, 4"Opy _t' wilp is -Ic77 aaa- 1. * Provide a copy of current Department of Revenue CT-3T Retail Excise Unit License. FEE: $150.00 CT-3T NUMBER: 4*7-1"TA3 V- a/3ds/7(•//��p FEDERAL ID/SS NUMBER: 04-2843586 SIGNATURE: DATE: rt -d Commonwealth of Mauahtnetts LeualD L1491887624 Department of Revenue Notice Date September 17 2018 Chmtopher C Harding Commimiamr Account ID CRL 10011037A89 a'OyrM mus goy/dot RETAILER LICENSE FOR SALE OF CIGARS AND SMOKING TOBACCO Indur�llr�url,�r�ll'�I�ri�p"ul�up�ui��nlgll�hr�tr�n CUMBERLAND FARMS MC CUMBERLAND FARMS 00176 CUMBERLAND 165 FLANDERS RD WESTBOROUGH MA 01581.1032 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 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 in DETACH HERE " MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T Retailer License for Sale of Cigars and Smoking Tobacco �a This license roust be posted and visible at oil times The sale of tobacco products to anyone under 18 years of age is prohibited CUMBERLAND FARMS INC Account ID CRL-10031037A89 CUMBERLAND FARMS N0187 Location ID 10031037-0679 30 CHAUNCY ST License Number 2130876416 MANSFIELD MA 02048-1958 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 yy ,, ucr di Commonwealth of Mossachusens Depanmrnt of Rcvcnuc ChrivophcrC Harding Comanutoncr mesa govidor Lencr ID L1700795008 Noam Datc Sepicmbcr 18 2018 AmountiD CGL 100MOVA86 RETAILER LICENSE FOR SALE OF CIGARETTES IIIrultuthudUhullttalrlPIP411rttdmllduluH4lrrl CUMBERLAND FARMS INC CUMBERLAND FARMS 010176 CUMBERLAND 165 FLANDERS RD WESTBOROUGH MA 01581.1032 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 MassTaxConnect 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 in to 4 30 p in DETACH HERE 0 HOgFj� MASSACHUSETTS DEPARTMENT OF REVENUE Form CT-3T � � w Retailer License for Sale of Cigarettes ppAT OFP This license must be posted and visible at all times The sale of tobacco products to anyone under 18 years of age is prohibited. CUMBERLAND FARMS INC Account ID CGL-10031037486 CUMBERLAND FARMS H0187 Location ID 10031037-0481 30 CHAUNCY ST License Number 447399936 MANSFIELD MA 02048-1958 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 A check mark signifies your understanding and agreement. I understand and agree that: CP'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. Er�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. LK I must consent to unannounced, periodic inspections and compliance checks of the permitted retail establishment. C"1'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. P' 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. Pf Non-residential Roll -Your -Own machines are prohibited. l?' Blunt wraps are prohibited. H' Penalties for violation of the regulation include monetary fines and/or suspension of this permit for seven or thirty days. er 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. Ll- I must prominently display a copy of the "Permit to Sell Tobacco and Nicotine Delivery Devices". CX 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). 9 1 must display Department of Public Health signs stating, "Sale of tobacco to Minors is prohibited". S3 I must display signs provided by the Board of Health that discloses referral information about cessation. CY 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 PXoduyts" and agree to abide by it. Signature Print Name Date 21. F Tobacco Product Sales — Cigarettes, Cigars, Chewing Tobacco, Rolling Papers, and E Cigarettes Cumberland Farms is dedicated to being a responsible tobacco vendor All Team Members must comply with the laws concerning the sale of tobacco products to minors The burden is on the customer to prove they are of legal age If they refuse to provide proper identification, refuse the sale In most states, civil penalties for selling cigarettes to minors can be levied against an individual Team Member, as well as the Company The following procedures must be followed at all times A violation of the procedures that results in the sale of tobacco products to anyone under eighteen (18) years of age will be addressed with progressive counseling up to an including termination Exceptions exist in towns in Massachusetts and Long Island, New York locations where the legal age ranges between nineteen and twenty-one (19-21) years of age Please check with your Store Manager to confirm the legal age to sell tobacco products in your store 1 Tobacco products must not be sold to anyone less than eighteen (18) years of age Long Island, NY prohibits anyone less than nineteen (19) years of age and select exception towns in MA where the age is between nineteen and twenty-one (19-21) years of age, from purchasing tobacco products 2 Anyone appearing to be 30 years of age or under must be asked for the proper picture identification for proof of age In the State of New York, identification must be requested from any customer appearing to be 30 years of age or under, regardless if the same customer provided identification in the past Acceptable forms of identification are • U S or Canadian Issued Photograph Driver's License • U S or Canadian Issued Photograph Non -Driver Identification • U S Active Military Photograph Identification • U S Passport with Photograph • Enhanced Driver's license Team Members must look for signs of forgery or alterations such as erasures, type-overs, cutouts and overall workmanship of the identification Check and compare the photo on the identification to the customer, be sure it's the same person 3 If a person's age is unverifiable due to lack of proper identification, refuse the sale 4 More than one form of identification should be checked when an ID is questionable 5 If there is any doubt after checking the identification for proof of age, refuse the sale 6 Written notes from parents or guardians granting a minor "permission" to purchase tobacco products are prohibited No one under the age of 18 may purchase tobacco products under any circumstances 7 Team Members should watch for indications of legal -aged customers attempting to purchase tobacco for minors If you believe the tobacco product is destined for the under -aged customer, even if the legal - aged customer is the minor's parent, refuse the sale Indications would include minors handing money to legal aged customers, minors handing the Team Member money for the purchase made by a legal - aged customer, a legal aged customer purchasing a variety of cigarette brands 8 If a customer becomes irate when asked for identification, explain that Federal law and Company policy requires you to ask for ID when a customer appears to be 30 years of age or under If the customer remains upset or becomes uncooperative, offer to let them talk to the Store Manager or Area Sales Manager Be polite and calm 9 A customer may only purchase 10 cartons of cigarettes in a (24) twenty-four hour period 10 Once you have established, through proper identification that a customer can legally purchase tobacco products, the ID card must be scanned into the register or the date of birth found on the identification card must be entered into the register, so that it is recorded on the electronic journal