Form 4260 - C-104a Declaration Of Ending Inventory Of Unaffixed Michigan Cigarette Stamps

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Michigan Department of Treasury
4260 (04-10)
C-104A: Declaration of Ending Inventory of Unaffixed Michigan Cigarette Stamps
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
Stamp Denominations (Number of Stamps)
Regular
Tribal
6.
7.
8.
9.
10.
20's
25's
1's
20's
25's
10. Ending Physical Inventory
(Include damaged stamps still in inventory)
Attach to your Michigan WC-100 or AC-100 Forms.

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