CITY OF WORCESTER, MASSACHUSETTS
Department of Health & Human Services
Division of Public Health
Application to Sell Tobacco Products, INCLUDING NICOTINE DELIVERY PRODUCTS Checklist
Attached are the required forms to sell tobacco products, including nicotine delivery products, within the City of Worcester. Please complete every applicable item. Incomplete applications will not be accepted and will be returned.
□ Completed application for a permit to sell tobacco products
□ For smoking bars (cigar/hookah) only: Copy of valid Massachusetts State Smoking Bar License from
MA Department of Revenue (DOR)
□ Copy of all three current MA Department of Revenue (DOR) Tobacco Retailer Licenses- Sale of Cigarettes, E Cigarettes and Sale of Cigars and Smoking Tobacco
□ Tobacco Permit Application Fee: $250.00, REQUIRED UPON NOTICE OF APPROVAL – Please make check payable to the City of Worcester
□ Please add the store address to the memo line of your check.
□ Applications received after December 31st: add $50.00 for a late fee
□ Statement of Declaration must be signed.
□ For new permit applicants, pre-opening inspections are mandatory. Please schedule an appointment with the tobacco inspector at 508-799-8531 ext. 33125.
Please visit www.worcesterma.gov for the complete City of Worcester Tobacco Ordinance, Sale of Tobacco Products Regulations, and Cigar & Flavored Tobacco Regulations.
The Division of Public Health may review quarterly DOR reports for all cigar and hookah bars.
Should the establishment discontinue selling tobacco products or should the establishment close, the Division of Public Health must be notified in writing to Karyn E. Clark, Director of Public Health.
If you have any questions, please contact the Worcester Division of Public Health at 508-799-8531 ext 33125.
Karyn E. Clark
Director of Public Health