Tobacco Tax Forms & Schedules

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Electronic Filing – Effective April 2005

 

Form Number Form Name
4028 Schedule M - Bad Debt Deduction
4154 Tobacco Products Electronic Filing Application
4239 Tobacco Products EFT Credit Application
4240 Tobacco Products EFT Debit Application
4241 Tobacco Products Payment Proposed Adjustment Coupon
4855 Monthly PACT Act Report - Cigarette Sales Report
4856 Monthly PACT Act Report – Tobacco Sales Report

 

Application/License Information

 

Form Number Form Name
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 Instruction

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

 

Tobacco Purchases via the Internet

 

Form Number Form Name
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
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
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
3762  2018 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

2018 Quarterly Statement of Deposit by Nonparticipating Manufacturer (NPM)

5531 2017 Annual Certification of Compliance by Nonparticipating Manufacturer (NPM)
5532 Annual Reconciliation for 2017 Escrow Deposit