Tobacco Tax Forms & Schedules
Fillable Forms Disclaimer
Many tax forms can now be completed on-line for printing and mailing. Currently, there is no computation, validation, or verification of the information you enter, and you are still responsible for entering all required information. Instructions may require some information to be handwritten on the form (signatures, for example).
For security reasons, you should press the "Reset Form" button after printing your completed form to clear your personal data. This button is located on the top of right corner of the form.
You will need Adobe Acrobat Reader installed to view the tax forms listed below.
Electronic Filing – Effective April 2005
| Form Number | Form Name |
|---|---|
| 4028 | Schedule M - Bad Debt Deduction |
| 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) |
| 337 | Tobacco Tax License Application Instructions |
| 4857 | Tobacco Manufacturer's Representative Permission List |
| 5575 | Tobacco Tax License Application Signature Page |
| 702 | Motor Fuel/Tobacco Surety Bond |
Tobacco Purchases via the Internet
| Form Number | Form Name |
|---|---|
| 4096B | Michigan Tobacco Products Tax Return For Untaxed Cigarettes and Other Tobacco Products Purchased through October 31, 2012 |
| 4096C | Michigan Tobacco Products Tax Return for Untaxed Cigarettes, Premium Cigars and Other Tobacco Products Purchased November 1, 2012, through October 31, 2021 |
Tobacco Stamping
| Form Number | Form Name |
|---|---|
| 323 | Application for Other Tobacco Products Stamp |
| 3371 | Stamping Agent Agreement |
| 3383 | Damaged Cigarette Stamp Returns |
| 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 | 2020 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 |
2020 Quarterly Statement of Deposit by Nonparticipating Manufacturer (NPM) |
| 5531 | 2019 Annual Certification of Compliance by Nonparticipating Manufacturer (NPM) |
| 5532 | Annual Reconciliation for 2019 Escrow Deposit |
