Tobacco Tax Forms & Schedules

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Electronic Filing – Effective April 2005

 

Form Number Form Name Associated Form Number Associated Schedule
4028 Schedule M - Bad Debt Deduction    
4154 Tobacco Products Electronic Filing Application 3999 Motor Fuel/Tobacco Trading Partner Agreement
    4239 Tobacco Products EFT Credit Application
    4240 Tobacco Products EFT Debit Application
    4241 Tobacco Products Payment Proposed Adjustment Coupon
4179 WC- MI Wholesale Cigarette Tax Return 4247 C-101- Schedule of Cigarette Purchases (Receipts)
4246 AC- MI Unclassified Acquirer Cigarette Tax Return 4251 C-102- Schedule of Cigarette Credits (Adjustments)
    4252 C-108- Schedule of Cigarette Sales (Disbursements)
    4253 C-115- Schedule of Cigarettes Sold to Michigan Tribes
    4254 C-103-Schedule of Out-of-State Cigarette Shipments (MI based; Exports Only )
    4260 C-104A-Declaration of Ending Inventory of Unaffixed Michigan Cigarette Stamps
    4261 C-104B- Declaration of Cigarettes in Inventory Stamped for Another State
4244 WT-MI Wholesaler of Other Tobacco Products Tax Return 4255 T-115- Schedule of Other Tobacco Products Sold to MI Tribes
4245 AT-MI Unclassified Acquirer of Other Tobacco Products 4256 T-108- Schedule of Other Tobacco Products Sales (Disbursements)
    4257 T-103 Schedule of Out-of-State Other Tobacco Products (Exports)
    4258 T-102- Schedule of Other Tobacco Products Credits (Adjustments)
    4259 T-101- Schedule of Other Tobacco Products Purchases (Receipts)
4344 T-108M- Manufacturer Schedule of Other Tobacco Products Sales (Disbursements)    
4345 C-108M - Manufacturer Schedule of Cigarettes Sales (Disbursements)    
4855 Monthly PACT Act Report - Cigarette Sales Report    
4856 Monthly PACT Act Report – Tobacco Sales Report    

 

Application/License Information

 

Form Number Form Name Associated Form Number Associated Schedule
151 Authorized Representative Declaration (Power of Attorney)    
163 Notice of Change or Discontinuance    
323 Application for Non-Cigarette Tobacco Products Stamps    
336

Tobacco Products License Application

   
4857 Tobacco Manufacturer's Representative Permission List    
702 Motor Fuel/Tobacco Surety Bond    

 

Tobacco Purchases via the Internet

 

Form Number Form Name Associated Form Number Associated Schedule
4096A Michigan Tobacco Products Tax Return For Untaxed Cigarettes and Other Tobacco Products Purchased on or after August 1, 2002 through June 30, 2004    
4096B Michigan Tobacco Products Tax Return For Untaxed Cigarettes and Other Tobacco Products Purchased on or after July 1, 2004    

 

Tobacco Stamping

 

Form Number Form Name Associated Form Number Associated Schedule
3371 Stamping Agent Agreement    
3383 Request for Adjustment to Cigarette Stamp Inventory    
5115 Stamping Agent Certification of Existing Equipment    
5171 Stamping Agent Reimbursement Application for “Eligible Equipment"    
5191 Application for Compensation for Certain Upgrades to Cigarette Tax Stamping Technology and Equipment    
5210 Application for Compensation for Purchases of Certain Cigarette Case Packers and/or Conveyors by Eligible Stamping Agents    

 

Tribal

 

Form Number Form Name Associated Form Number Associated Schedule
3592 Claim for Tobacco Tax Refund    
3593 Summary of Sales Worksheet/Tribal Government or Tribal Members    
3598 Indian Country Information Inquiry    

 

Non-Participating Manufacturer

 

Form Number Form Name Associated Form Number Associated Schedule
3762 2017 Quarterly Certification of Compliance by Nonparticipating Manufacturer (NPM)    
4126 Equity Assessment Prepayment Report for Non-Participating Manufacturers (NPM) of Cigarettes and/or Roll Your Own Tobacco    
5465

2017 Quarterly Statement of Deposit by Nonparticipating Manufacturer (NPM)

   
5531 2016 Annual Certification of Compliance by Nonparticipating Manufacturer (NPM)    
5532 Annual Reconciliation for 2016 Escrow Deposit