The Arkansas ATC R4 form is a vital document that ensures compliance with state laws regarding the sale of tobacco products. It requires employees to acknowledge their responsibilities and prohibitions when selling tobacco, particularly the importance of not selling to anyone under the age of 18. Properly completing and maintaining this form is essential for any business involved in the sale of tobacco, as it helps protect both the employee and the establishment from legal repercussions.
To fill out the form, please click the button below.
The Arkansas ATC R4 form is a critical document utilized within the state’s tobacco retail environment. It serves as a Tobacco Server Awareness Form that employees must complete upon their employment. Each employee is required to initial and sign the form, acknowledging their understanding of the responsibilities and prohibitions associated with the sale of tobacco products. The form emphasizes the legal age restrictions, specifically prohibiting sales to individuals under 18 years of age, and outlines the consequences of non-compliance. In addition, it specifies that selling single cigarettes or smaller quantities than a full pack is not permitted. The form must be retained on-site, ensuring it is accessible for inspection by Arkansas Tobacco Control officials. By signing, employees affirm their commitment to adhere to both state law and the policies of their employer regarding tobacco sales. This form plays a vital role in promoting responsible tobacco sales and compliance with state regulations.
DFA - ARKANSAS TOBACCO CONTROL
State of Arkansas
101 E. Capitol Ave., Suite 401
Little Rock, AR 72201
Department of Finance
Phone: (501)
682-9756
And Administration
Fax: (501)
682-9760
https://www.atc.arkansas.gov
TOBACCO AND VAPOR SERVER AWARENESS FORM
Upon employment, all employees must initial each section, sign, and date this document before selling any tobacco, vapor, alternative nicotine, or e-liquid products. This form is to be kept on file at the store, be accessible to any clerk or employee present, and be available at all times for inspection by any employee of Arkansas Tobacco Control.
As an employee of a permitted outlet, I understand that there are certain things I am prohibited from doing and certain actions that I cannot allow to occur in the outlet. In accordance with Arkansas law and the rules of Arkansas Tobacco Control, I have read, initialed and acknowledged the following:
(Please initial below)
I will not sell cigarettes, tobacco products, vapor products, alternative nicotine products or e-liquid products
to anyone 21 years of age or older when I know the products will be provided to a person or persons under the
age of 21.
_______
I understand that cigarettes or “tobacco products” includes any substance that contains tobacco, including
but not limited to, cigarettes, cigars, smokeless tobacco, loose tobacco, hookah tobacco, shisha, and cigarette
papers.
I will not sell single cigarettes or any number of cigarettes less than a full pack (20 or 25 cigarettes packaged
together constitutes a pack) and I understand it is against the law to do so.
________
I understand that sales to anyone under the age of 21 can result in criminal charges being filed against me. I
understand that as a clerk, if I am found guilty of a violation of A.C.A. § 5-27- 227, I shall be subject to a fine up to
$100 per violation, plus local court costs.
I understand that this store may undergo inspection at any time to assess its compliance with the state law
regarding the sale of cigarettes, tobacco products, vapor products, alternative nicotine products or
e-liquid products to a minor under the age of 21.
I understand it is illegal to reuse or refill tobacco boxes with cigars, little cigars, cigarillos or any other tobacco product. Any person doing this can be charged with a Class D Felony.
By signing below, I hereby certify that I have read and fully understand the above statements. I agree to always follow state law and not to sell cigarettes, tobacco, vapor, alternative nicotine, or e-liquid products to minors. I further consent to allowing any current or potential employer to contact Arkansas Tobacco Control to determine if I have received any citations for violations of Title 5, Chapter 27 of the Arkansas Code.
Employee Signature
Date Signed
Printed Name of Employee
Date Entered Employment
Signature of Owner, Manager or Supervisor
FORM ATC R-4 02/2020)
(All blank lines on this form must contain information)
Dmv Handicap Parking - It offers a clear pathway for complying with state tax regulations, minimizing legal complications.
The New York Trailer Bill of Sale is a legal document used to transfer ownership of a trailer from one party to another. This form provides essential details about the transaction, including the buyer and seller's information, trailer specifications, and sale price. For more information on this important legal tool, you can visit NY Documents. Understanding this document is crucial for ensuring a smooth transfer and protecting the rights of both parties involved.
Child Neglect Examples - It contains fields for detailing specific instances of physical, emotional, or sexual abuse, as well as neglect, to assist in the accurate assessment and intervention by child protective services.
Amft 71 Arkansas - It serves as a comprehensive application that covers all necessary details for IFTA registration.