Form 4261 - C-104b Declaration Of Cigarettes In Inventory Stamped For Another State

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Michigan Department of Treasury
4261 (04-10)
C-104B: Declaration of Cigarettes in Inventory Stamped for Another State
Licensed Wholesaler Informational Report Only.
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)
5. Branch Location Code
6. Stamp Inventory for the state of:
Stamp Denominations (Enter Number of Sticks)
Regular
Tribal
7.
8.
9.
10.
11.
20's
25's
1's
20's
25's
Ending Physical Inventory
(Include unsalable cigarettes still in inventory)
Attach to your Michigan WC-100.

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