Form 336 - Tobacco Tax License Application - 2011 Page 5
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5Form 336, Page 5
PART 7: CERTIFICATION
Each and every owner, officer, partner or member listed in Part 2 above must sign this application.
IN SIGNING THIS APPLICATION, I AGREE to comply with the provisions of the Tobacco Products Tax Act, 1993 PA 327. I declare
UNDER PENALTY OF PERJURY that I have examined the information on this application, including any accompanying statements or
attachments, and that, to the best of my knowledge, it is true and complete. I authorize the Michigan Department of Treasury to fax
confidential tax information of the business to the fax number provided on this application. I recognize that faxing is not a secure means
of transmission and I assume all risks involved.
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Instructions for the Tobacco Tax License Application (Form 336)
If you only plan to operate as a retailer of cigarettes or other tobacco products, you do not need a Michigan tobacco tax license. A retailer
of tobacco products is a business that (1) purchases all of its cigarettes or other tobacco products from a Michigan tobacco tax licensee
who has paid Michigan tobacco tax on the tobacco and (2) only sells that tobacco to consumers — not to other businesses.
If you are a NEW APPLICANT, you must attach (1) proof that the business has a minimum net worth of $25,000.00 and (2) a copy of a
picture identification such as a driver’s license, passport or similar ID for each officer, shareholder, member or partner of the corporation,
and photos of the physical location where tobacco products will be stored and sold.
If you are applying for a NEW WHOLESALER OR UNCLASSIFIED ACQUIRER LICENSE, you must attach the following forms to this
completed application:
• Form 4154 – Tobacco Products Tax Electronic Application. This form will provide you with a password so you can use the
Department’s Web site to complete your monthly tobacco tax return.
• Form 4240 – Tobacco Products Electronic Funds Transfer (EFT) Debit Application. This form will provide you with a password so
you can pay your taxes electronically.
• Form 323 – Application for Non-Cigarette Tobacco Products Tax Stamp.
If you are applying for a NEW Secondary Wholesaler license, you must attach the following form to this completed application:
• Form 4154 – Tobacco Products Tax Electronic Application. This form will provide you with a password so you can use the
Department’s Web site to complete your monthly tobacco tax return.
• A picture of the physical location where tobacco products will be stored and sold.
If you are RENEWING your current license, you must attach a current financial statement including a balance sheet. (This requirement
does not apply to Manufacturers or Vending Machine Operators.)
If you need Tobacco Tax forms, go to If you have questions, contact the Tobacco Tax Unit at (517)
636-4630 (telephone) or (517) 636-4631 (fax).
Mail your original application, any necessary statements or attachments and the proper fee to:
Special Taxes Division
Michigan Department of Treasury
P.O. Box 30474
Lansing, MI 48909-7974
Failure to provide all of the information requested will delay the processing of your application. Please make a copy of this application
for your records in case you need to discuss it with the Department of Treasury.
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