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Form 4254, Page 2

Instructions for Completing Form 4254,

C-103: Schedule of Out-of-State Cigarette Shipments (Michigan Based Licensees Exports Only)

This schedule along with the return must be filed each

Column 6. Enter the date on the invoice.

Due Date

month by all Michigan Licensed Wholesalers and Michi-

Column 7. Enter the invoice number

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

gan Based Unclassified Acquirers of Cigarettes. A return

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

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

must be filed even if you do not have any tax due. In this

one location that submits its tax information under the

the 20th of the month following the reporting period.

instance simply check the “no tax due” box on the WC-

same account number. The branch code is the State of

Late filed Returns

100 or AC-100, sign the return and send it to the depart-

Michigan License number assigned to the branch.

Returns which are not timely filed are subject to the fol-

ment. To report other tobacco products purchases use

Column 9. Enter the federal employer identification num-

lowing statutory charges:

Schedule T-103.

ber of the company that you sold the tobacco to.

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

Column 10. Enter the name of the person whom the

How to Complete This Schedule

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

product was sold to.

Check the appropriate box to indicate the schedule type.

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

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

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

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

business

purchasing

the

tobacco.

Visit

for each transaction or invoice. In some instances an

with an additional 5% penalty for each additional month

to obtain the codes.

invoice may be recorded more than once if there is more

or fraction of month late. Maximum penalty 25%.

Column 12. Enter the city that the company purchasing

than one manufacturer’s product on the invoice. Invoices

the tobacco products is located in.

Assembling Your Return for Mailing

that contain NPM’s product must be recorded by each

Column 13. Enter the state that the company that is

Assemble the supporting schedules that you attach to

brand purchased from the NPM. Invoices that have more

purchasing the tobacco products is located in.

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

than one type of pack size (number of cigarettes in the

Column 14. Indicate the number of cigarettes in the pack

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

pack) must have a separate line entry to report each differ-

for each brand received for both participating manufac-

ent pack size.

Record Keeping

turers and NPM’s. If the size of the pack is the same for all

You must keep a complete copy of your return and all

Schedule Descriptions

cigarettes on the invoice, the invoice needs to be entered

records pertaining to your business for at least four years.

Schedule C-103a: This schedule is to be used to record

only once, if there are multi-sized packs on the invoice the

The records must be kept in a place and manner easily

all stamped cigarettes for sale or transfer into another state.

invoice must be recorded as many times as needed. (i.e.

accessible for review by department representatives.

Indicate the name of the state the tobacco was transferred

20, 25 and 10).

to.

Complete columns 15 through 18 only if the cigarettes

Assistance

Schedule C-103b: This schedule is to be used to record

that you are reporting are manufactured by a non-par-

You may contact the Tobacco Taxes Unit by phone at

all unstamped cigarettes for sale or transfer into another

ticipating manufacturer.

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

state. Indicate the name of the state the tobacco was trans-

Column 15. Enter the Federal Employer Identification

treas_tobaccotaxes@michigan.gov. The mailing address

ferred to.

Number, TR or ME Number of the NPM.

is Michigan Department of Treasury, P.O. Box 30474,

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

Column 16. Enter the Name of the NPM.

Lansing, MI 48909-7974. Information and forms are

tobacco tax license.

Column 17. Enter the Non-participating manufacturer’s

available online at .

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

three-digit brand code that can be obtained from our

License Cancellation

ber) that appears on your tobacco tax license.

website .

See WC-100 or AC-100 forms for instructions.

Line 3. Enter the license number from your state of Michi-

Column 18. List each brand of the NPM’s cigarettes that

Name/Address/Ownership Changes

gan Tobacco Products License.

were sold on a separate line for each invoice number. Some

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

invoices may be recorded more than once.

See WC-100 or AC-100 forms for instructions.

(i.e. 01/2005).

Column 19. Enter the total number of cigarettes sold for

Mailing Address

Schedule Type: Select the appropriate schedule type.

each manufacturer’s brand or pack size.

Mail completed return and schedules with the appropriate

(Choose one).

Line 20. Total the column and carry over to WC-100 or

payment to:

Michigan Department of Treasury

Column 5. Enter the date the tobacco products were

AC-100.

P.O. Box 77628

shipped to an out-of-state customer.

Detroit, MI 48277

Form 4254 - C-103 Schedule Of Out-Of-State Cigarette Shipments (Michigan Based Licensees Exports Only) Page 2

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