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under penalty of perjury, in an electronic format established by the Department, the following information: (1) the name and address of the applicant; (2) the address of the location at which the applicant proposes to engage in business as a retailer of cigarettes in this State; and (3) such other additional information as the Department may lawfully require by its rules and regulations. The annual license fee payable to the Department for each retailer's license shall be $75. The fee shall be deposited into the Tax Compliance and Administration Fund and shall be for the cost of tobacco retail inspection and contraband tobacco and tobacco smuggling with at least two-thirds of the money being used for contraband tobacco and tobacco smuggling operations and enforcement. Each applicant for a license shall pay the fee to the Department at the time of submitting its application for a license to the Department. The Department shall require an applicant for a license under this Section to electronically file and pay the fee. A separate annual license fee shall be paid for each place of business at which a person who is required to procure a retailer's license under this Section proposes to engage in business as a retailer in Illinois under this Act. (b) The following are ineligible to receive a retailer's SB3019 Enrolled LRB104 20255 HLH 33706 b Public Act 104-0468