20250604105630067

STATE OF CONNECTICUT
DEPARTMENT OF REVENUE SERVICES
Telephone: 860-297-4885
ORS Website: portal.ct.gov/DRS
myconneCT Portal: portal.ct gav/ORS-myconneCT
instructions: Ensuré thal the “Applicant seclion
below has been completed and the information in
ithe “Business Information” section is correct.
Then prasant to the town clerk of the municipality
where the business is [to be} lacated. Have the
town clerk acknowledge receipt of this notifeation.
(Once completed, return to the myconneCT portat
land complete tha acknowledgement retumn.
NOTICE OF APPLICATION FOR A CIGARETTE DEALER/RETAILER LICENSE
Department of Revenue Services, 450 Columbus Blvd, Suite 1, Hartfard, CT 06103-1837
License Case Number: 674317
Name of Applicant
- BABAR MEMM0OD
§ Residential Address
s| 2280 NOSTRAND AYE fT EM
* WResidential City, State Zip
Ekaokl IW NY VYRAI
Business Information
DMS O5 LLG
e GUJJAR MART
@ 126 NORWICH RD
= QUAKER HILL CT 08375-1125
o
Certification of Receipt by Town Clerk
This application has been received by the clerk of the municipality for the above listed business.
ag) L Lag 6/3/25
Bignature or town Clerk — Daid Received
Oa ve d ZL _Cemlo
Print Name °
The above noted applicant has applied for a Cigarette Dealer/Retailer License by submitting a registration application to
the Connecticut Department of Revenue Services (DRS).
A copy of this notice must be provided to the clerk of the municipality where the business Is to be located.
The clerk must post and maintain this notice on the website of the municipality for at least a two-week period,
Not later than the day following the date an applicant provides notice to the clerk of the municipality, the applicant shall
affix a copy of this notice, which shall be maintained in a legible condition, upon the outer door of the building where such
place of business is to be located.
If an application is filed for a license for a building that has not yet been constructed, the applicant shall, not later than the
day following the date an applicant provides notice to the clerk of the municipality, erect and maintain in a legible
condition on the site where the business is to be located, a sign that:
{A) is not less than six feet by four feet,
(B} contains the license applied for and the name of the proposed licensee, and
(C} is clearly visible from the public highway.
450 Columbus Blvd., Suite, 1 File Your Taxes Electronically Hartford, CT 06403-1837
portal.ct.goviDRS
Affirmative Action / Equal Opparturtity Employer 1

Instructions For Applicant
Pursuant to Connecticut General Statute 12-287, you, the applicant, must now complete the following:
The Applicant section of the NOTICE OF APPLICATION FOR A CIGARETTE DEALERY RETAILER LICENSE.
Give a copy of the notice to the clerk of the municipality where the business is to be located so they can post the
notice on the municipality's website for a period of no less than 2 weeks time.
* Not later than the day following the date an applicant provides notice to the clerk of the municipality where the
business Is to be located, the applicant shall affix a copy of this notice, which shall be maintained in a legible
condition, upon the outer door of the building. ‘
{f an applicatian is filed for a license for a building that has not yet been constructed, the applicant shall, not later
than the day following the date an applicant provides notice fo the clerk of the municipality, erect and maintain in a
lagible condition on the site where the business is to be located, a sign that:
* (A)is not less than six feet by four feet,
* (B) contains the license applied for and the name of the proposed licensee, and
+ (C}is clearly visible from the public highway.
Retum and jog into your myconneCT account with DRS and complete the Acknowledgment return. You can access
this return from within the Action Genter of your account, You will need to declare under oath that the specified
requirements have been met. When filing the return, you will need to authorize the payment of the associated fee,
After filing (he return with DRS, provide an additional 3 weeks, after the notice has been posted on the municipality
website for 2 weeks, for any 10 persons who are residents of the municipality where the business is located to file a
remonstrance containing objection to the suitability of such place of business provided any such issue is not controlled by
local zoning.
DRS may hold a hearing as to the suitability of the proposed location.
480 Columbus Bivd., Suite. 1 File Your Taxes Electronically Hartford, CT 06103-1837
portal.ct.goviDRS
Affirmative Action / Equat Opparturity Employer 2