Form 336 - Tobacco Tax License Application - 2011 Page 4
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5Form 336, Page 4
PART 5: MANUFACTURER’S LICENSE
If you are applying for a Manufacturer’s License, complete this section. Include a copy of your Federal Manufacturer of
Tobacco Product (MTP) permit. Attach additional sheets if necessary.
Indicate below which type of manufacturer applies to you:
I am on the NAAG list of Participating Manufacturers. ( )
I am a Non-participating Manufacturer approved to sell tobacco products in the state of Michigan.
I am a manufacturer of Other Tobacco Products, including cigars and hookah.
Manufacturer will have in-state manufacturer representatives.
If checked, complete and attach the Tobacco Manufacturer’s Representative Permission List, Form 4857.
Brand Family of CIG or RYO
Tobacco Type
(You do not need to provide the brand family of OTP)
CIG
RYO
OTP
CIG
RYO
OTP
CIG
RYO
OTP
CIG
RYO
OTP
CIG
RYO
OTP
PART 6: VENDING MACHINE OPERATOR’S LICENSE
If you are applying for a vending machine operator’s license, complete this section. Attach additional sheets if necessary.
Number of vending machines in use
Number of vending machines in storage
Total number of vending machines
List below the business names and addresses where each vending machine is located.
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