Form 4252 - C-108 Schedule Of Cigarette Sales (Disbursements)

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Michigan Department of Treasury
4252 (Rev. 04-10)
C-108: Schedule of Cigarette Sales (Disbursements)
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-108a: Schedule of Untaxed Cigarette Sales in Michigan to Licensed Wholesalers (Out-of-State Unclassified Acquirers Only)
C-108b: Schedule of Cigarette Sales in Michigan from Tax-Unpaid Inventory
C-108c: Schedule of Cigarette Sales from Tax Paid Inventory
C-108d: Schedule of Cigarette Sales in Michigan to U.S. Agencies
Non-Participating Manufacturer Product
19. Total
Sold To Information
Address of Purchaser
Manufacturer
Brand
14. Pack
5. Date
6. Invoice
7. Invoice
8. Branch
Cigarettes per
Size
Sold
Date
Number
Code
12. City
13. State
17. Code
9. FEIN
10. Name
15. FEIN
16.Name
18. Name
11. Type
entry
20. TOTAL
Attach to your Michigan WC-100, AC-100, or SC-100 Forms.

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