Form 336 - Tobacco Products Tax License Application - 2009
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4Michigan Department of Treasury
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336 (Rev. 8-09)
Tobacco Products Tax License Application
Issued under authority of P.A. 327 of 1993, as amended. Filing is mandatory.
Failure to provide all information will delay the processing of your application.
New License
Renewal
The license year runs from July 1 through June 30, ______.
INSTRUCTIONS: Complete each line on this form correctly and completely. Indicate N/A if a line is not applicable to your
application. Incomplete applications will not be processed and licenses will not be issued or renewed if a line is left blank.
Under no circumstances are tobacco products to be acquired from an unlicensed source or any sales for resale made before
issuance of license and/or receipt of the authorized stamp for placing impressions on the case of the tobacco products.
PART 1: IDENTIFYING INFORMATION
Complete each line. Enter N/A if not applicable.
1. Type of Ownership:
Individual
Partnership
Other:______________________________________
Domestic Corporation
Foreign Corporation
Trust/Estate
LLC (Limited Liability Corporation) Number________________________________________________
S Corporation
LLP (Limited Liability Partnership) Number ________________________________________________
2. Legal Name of Corporation or Individual
3. Account Number (FEIN, TR, or ME Number)
5. Business Telephone Number
6. Business Fax Number
4. Trade Name (DBA)
7. Legal Address (Street, RR#, P.O. Box, City, State, ZIP Code)
8. Mailing Address (Street, RR#, P.O. Box, City, State, ZIP Code)
Indicate if new address
Indicate if the same as #7.
9. Physical Location of Business where tobacco will be stored (Not P.O. Box)
10a. Licensing Contact Name
10b. Licensing Contact Telephone No.
Indicate if new location
10c. Licensing Contact Fax Number
10d. Licensing Contact E-mail address
Leased
Owned
11a. Tax Preparer Contact Name
11b. Tax Preparer Telephone Number
11c. Tax Preparer Fax Number
11d. Tax Preparer E-mail Address
11e. Tax Preparer Business Hours (M-F, 8-5, etc.)
PART 2: GENERAL INFORMATION
Complete each line. Enter N/A if not applicable.
12. From what type of secure, non-residential facility do you operate your business?
Commercial Building
Warehouse
Other:__________________________________
13. Do you have any branch locations? If Yes, provide description for each location (ie, warehouse, storage facility, etc).
Yes
No
14a. Are invoice/records stored at each location?
14b. Is an employee available at each location during normal business hours?
Yes
No
Yes
No
15. Address of Branch Location(s). Attach additional sheets if necessary.
Leased
Owned
Leased
Owned
Leased
Owned
16. Are current lease agreement(s) for all locations attached?
17. Who will the tobacco be sold to?
Yes
No
Retailers
Wholesalers
Consumers
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