Form 4251 - C-102: Schedule Of Cigarette Credits (Adjustments)

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Michigan Department of Treasury
4251 (1-05)
C-102: Schedule of Cigarette Credits (Adjustments)
Important: Read the instructions on Page 2 before completing this schedule.
1. Name
2. Account Number (FEIN, TR or ME Number)
3. Michigan License Number
4. Reporting Period (MM/CCYY)
CHECK ONE box below to identify what is itemized on this schedule. Do not combine schedule types or product codes.
C-102a: Schedule of Unstamped Cigarette Credits
C-102b: Schedule of Non Tax Paid Stamped Cigarette Credits
C-102c: Schedule of Tax Paid Stamped Cigarette Credits
Claim Filed Against: Manufacturer/
Non-Participating Manufacturer Product
Claim/Credit Information
Purchase Entry (C-101)
Wholesaler/ Unclassified Acquirer
10.
Manufacturer
Brand
19. Total Cigarettes
7. Credit
Branch
14. Pack
per Entry
5. Date
6. Number
Types
8. Invoice No. 9. Tax Period
11. FEIN
12. Name
13. Type
Code
17. Code
15. FEIN
16. Name
18. Name
Size
20. TOTAL
Attach to your Michigan WC-100 or AC-100 Forms.

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