Form 4257 - T-103 - Schedule Of Out-Of-State Other Tobacco Product Shipments

Form 4257, page 2

Instructions for Completing Form 4257,

T-103: Schedule of Out-of-State Other Tobacco Product Shipments (Michigan Based Licensees Exports Only)

This schedule along with the return must be filed each

Column 10. Enter the name of the person whom the

3. Penalty is 5% of tax due if not more than 2 months late

month by all Michigan Licensed Wholesalers, Secondary

product was sold to.

with an additional 5% penalty for each additional month

Wholesalers, and Unclassified Acquirers of Other

Column 11. Enter the two-digit code indicating the type

or fraction of month late. Maximum penalty 25%.

Tobacco Products. A return must be filed even if you do

of business you sold to. Visit

Assembling Your Return for Mailing

not have any tax due.

tobaccotaxes to obtain the codes.

Assemble the supporting schedules that you attach to

Column 12. Enter the city that the company that purchased

How to Complete This Schedule

your return (WT-100 or AC-100) in ascending numerical

the tobacco products is located in.

Check the appropriate box to indicate the schedule type.

order (i.e. T-101, T-102, etc.).

Column 13. Enter the state that the company that

Only mark one schedule type per form. Use a single line

Record Keeping

purchased the tobacco products is located in.

for each transaction or invoice. In some instances an

Column 14. Enter the wholesale price which is defined as

You must keep a complete copy of your return and all

invoice may be recorded more than once if there is more

the actual price paid for the tobacco product including

records pertaining to your business for at least four years.

than one manufacturer’s product on the invoice. Invoices

any tax, excluding any discounts.

The records must be kept in a place and manner easily

that contain NPM’s product must be recorded by each

Complete columns 15 through 19 only if the roll-your-

accessible for review by department representatives.

brand purchased from the NPM. Invoices that have more

own that you are reporting is manufactured by a non-

Assistance

than one NPM Brand of Roll-Your-Own must have a

participating manufacturer.

separate line entry to report each different brand name.

You may contact the Tobacco Taxes Unit by phone at

Column 15. Enter the Federal Employer Identification

(517) 636-4630, by Fax at (517) 636-4631, or by e-mail at

Schedule Descriptions

Number, TR or ME Number of the NPM.

treas_tobaccotaxes@michigan.gov. The mailing address

Schedule T-103: This schedule is to be used to record all

Column 16. Enter the Name of the NPM.

is Michigan Department of Treasury, Special Taxes

Other Tobacco Products for sale or transfer in another

Column 17. Enter the Non-participating manufacturer’s

Division, Tobacco Taxes, P.O. Box 30474, Lansing, MI

state.

three-digit brand code for Roll-Your-Own that can be

48909-7974. Information and forms are available online at

Line 1. Enter your business name as it appears on the

obtained from our Web site tobaccotaxes.

tobaccotaxes.

tobacco tax license.

Column 18. List each brand of the NPM’s Roll-Your-Own

License Cancellation

Line 2. Enter the account number (FEIN, TR or ME

that was sold on a separate line for each invoice number.

Number) that appears on your tobacco tax license.

Some invoices may be recorded more than once.

See instructions on WT-100, AT-100 or ST-100.

Line 3. Enter the license number from your state of

Column 19. Enter the total weight of Roll-Your-Own sold

Name/Address/Ownership Changes

Michigan Tobacco Products License.

for each manufacturer’s brand.

See instructions on WT-100, AT-100 or ST-100.

Line 4. Enter the tax period for which you are reporting.

Line 20. Total the wholesale price column and carry over

Mailing Address

(i.e. 01/2005). Schedule Type: Select the appropriate

to WT-100, AT-100, or ST-100.

schedule type. (Choose one). Indicate the name of the

Line 21. Total the ounces column.

Mail completed return and schedules with the appropriate

state the tobacco was transferred to.

payment to:

Due Date

Column 5. Enter the date the tobacco products were

Michigan Department of Treasury

Your return is due 20 days after the close of the month. To

shipped to an out-of-state customer.

P.O. Box 77628

be timely filed, a return must be postmarked on or before

Column 6. Enter the date on the invoice.

Detroit, MI 48277

the 20th of the month following the reporting period.

Column 7. Enter the invoice number

Late filed Returns

Column 8. Enter the branch code if you have more than

one location that submits its tax information under the

Returns which are not timely filed are subject to the

same account number. The branch code is the State of

following statutory charges:

Michigan License number assigned to the branch.

1. No tax due return $10.00 a day up to $400.00.

Column 9. Enter the federal employer identification

2. Interest on tax due accrues at 1% above current prime

number of the company that you sold the tobacco to.

rate; adjusted on 1/1 and 7/1 each year.

Form 4257 - T-103 - Schedule Of Out-Of-State Other Tobacco Product Shipments - 2010 Page 2

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