Form 4247 - C-101 Schedule Of Cigarette Purchases (Receipts) printable pdf download

Form 4247 - C-101 Schedule Of Cigarette Purchases (Receipts)

Michigan Department of Treasury

4247 (Rev. 04-10)

C-101: Schedule of Cigarette Purchases (Receipts)

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-101a: Schedule of Unstamped Cigarette Purchases (receipts) in Michigan (wholesalers only)

C-101b: Schedule of Michigan Stamped Tax Paid Cigarette Purchases (wholesalers or secondary wholesalers only)

C-101c: Schedule of Returned Stamped (tax-paid) Cigarettes from Michigan Customers

C-101d: Schedule of Other State Stamped Purchases. Enter the state for which product is stamped: _____________________________(wholesalers only)

Non-Participating Manufacturer Product

19. Total

Purchased from Information

Address of Seller

Manufacturer

Brand

5. Date

6. Invoice

7. Invoice

14. Pack

Cigarettes per

Branch

Size

Received

Date

Number

9. FEIN

10. Name

11.Type

12. City

13. State

15. FEIN

16. Name

18. Name

17. Code

entry

Code

20. TOTAL

Attach to your Michigan WC-100, AC-100 or SC-100 Forms.

Form 4247 - C-101 Schedule Of Cigarette Purchases (Receipts)