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Tobacco Tax Forms & Schedules

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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).

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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 - Cigarette (Traditional and RYO) Sales Report

Monthly PACT Act - Smokeless Tobacco Sales Report

5746 Monthly PACT Act - Cigarette (ENDS) Sales Report
5747 Monthly PACT Act - Cigarette (Little Cigars) 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


4096C Michigan Tobacco Products Tax Return for Untaxed Cigarettes, Premium Cigars and Other Tobacco Products Purchased
3943 Notice to Licensed Wholesalers and Unclassified Acquirers of Cigarettes and "Roll-Your-Own" Tobacco


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



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 2024 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 2024 Quarterly Statement of Deposit by Nonparticipating Manufacturer (NPM)
5531 2024 Annual Certification of Compliance by Nonparticipating Manufacturer (NPM)
5532 Annual Reconciliation for 2023 Escrow Deposit

 Modified Risk Productions


Form Number Form Name
5848 Tobacco Tax Notification of Modified Risk Order