San Juan County Public Health
             
San Juan County Health Department
735 S 200 W Suite 2, Blanding, UT 84511
Phone: (435) 587-3838

Tobacco Fine for Sale to a Minor

Business Information
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:

Date
Owner Name
Contact Phone Number
Contact person if different than owner
 
Fine Amount:   $500.00   Item Subtotal:  
$500.00
Total:
$500.00
 
Payment Information:
Processing Fee Rates:
Cards:2.5% ($1.50 min)
(1.5% additional service fee for foreign cards)
eCheck:$0.75
Method of Payment:
  Credit/Debit Card
  eCheck
 Update Name from Above
Organization Name: is required
Address: is required
City: is required
State/Province: is required
ZIP/Postal Code: is required
Phone: is required
Email: is required
Date is required
Owner Name is required
Contact Phone Number is required
You must enter a payment method.