State of Tennessee

Halting Tobacco Sales to Minors Complaint Form

The Tennessee Department of Agriculture conducts random unannounced inspections of locations where tobacco products are sold or distributed. The purpose of the program is to reduce minor access to tobacco products through various prohibitions and restrictions on the sale, distribution, and receipt of such products.

If you have witnessed a retail location in the state of Tennessee selling to minors under the age of twenty-one (21) years old, please fill and submit the form below.

Once received by the Department, inspectors from the Tennessee Department of Agriculture’s tobacco program will conduct an undercover inspection attempting to mimic the parameters that were in the complaint.

Your Information:

Name*

First Name

Last Name

Date*

Phone*

Would you like to remain anonymous?*

Yes No

Would you like to a copy of the results of the follow up inspection?*

Yes No

Where would you like the results sent?

Complaint Information:

Name of Firm:*

Address of Firm:*

Address Line 1

Address Line 2

City

State

ZIP Code

Date and Time of Occurence(s):

Details of Occurrence/ Other Comments:*

Product(s) Purchased:

Clerk Information: