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Retail Sales Tobacco Permit and Registration Application

  1. No permit will be given until payment is received in full and processed by the City of Gardner Health Department

  2. I, the above mentioned, hereby apply for a permit to sell any product containing tobacco within Gardner,MA. Tobacco includes but is not limited to cifarettes, cigars, chewing tobacco, snuff, pipe toacco, and smokeless tobacco. I acknowledge that I have read the City's Board of Health Regulations concerning the sale and distribution of tobacco in Gardner.

  3. This list only needs to be updated with the Board of Health when applying for the annual permit. The Board recognizes that there may be staffing changes throughout the year.

  4. Pursuant to M.G.L. CH. 62c, Sec. 49A, I certify under penalties of perjury, that I, to the best of my knowledge and belief, have filed all State tax returns and paid all State Taxes required by Law.

  5. By typing my name above I certify that all of the information is correct and in compliance with all of the necessary laws and regulations.

  6. No permit will be issued until payment is received in full and processed by the City of Gardner Health Department. Please send payment to Gardner Health Department, Gardner City Hall Rm 29, 95 Pleasant St. Gardner, MA 01440. The fee for this permit is $100.

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  8. This field is not part of the form submission.