Form M-108 - Credit For Cigarette Tax Stamp Rolls - 2011
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FORM M-108
StatE OF Hawaii - DEpaRtMEnt OF taxatiOn
CREDit FOR CiGaREttE tax StaMp ROLLS
(REV. 2011)
REtuRnED tO tHE DEpaRtMEnt OF taxatiOn
BY JunE 30, 2011
prepare in Duplicate
This form must accompany unused rolls of Hawaii cigarette tax stamps returned to the Department of Taxation for credit.
attach a copy of the receipts for the purchase of the stamps being returned and any incremental tax paid for those
stamps.
Name of Cigarette Tax Licensee
Cigarette Tax Stamps Purchase Approval Number (Assigned on Form M-100A)
Hawaii Tax Identification Number: w __ __ __ __ __ __ __ __ - __ __
Address
City
State
Postal/Zip Code
1. Amount of credit for each roll of Hawaii cigarette tax stamps (15,000 X $3.00) .............................
$45,000.00
2. Number of unused rolls of Hawaii cigarette tax stamps returned to the Department of Taxation ..
Serial numbers of rolls returned________________________________________________
3. Total credit due for the return of unused rolls of Hawaii cigarette tax stamps ................................ $
(Line 1 multiplied by line 2)
I declare, under the penalties set forth in section 231-36, Hawaii Revised Statutes (HRS), and the penalties for perjury, that this
is a true and correct statement of the return of unused rolls of Hawaii cigarette tax stamps.
Signature
Title
Print name of signatory
Date
FOR DEpaRtMEnt OF taxatiOn uSE OnLY
District Office
Credit verified by
Number of rolls returned:
Receipts presented?
Serial numbers verified:
Credit approved by:______________Date: __________
FORM M-108
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