Michigan Department of Treasury
4182 (6-04)
Michigan Tobacco Products Inventory Tax Return
Issued under P.A. 327 of 1993, as amended. Failure to file this return and/or remit the tax due may result in the
issuance of a computed intent to assess for tax, penalty and interest in accordance with P.A. 122 of 1941.
IMPORTANT
Inventory Must Be Taken on
June 30, 2004. Return and Tax Due
Must Be Filed by August 1, 2004.
Business Name and Address
Federal Employer Identification Number
Effective July 1, 2004, there is an increase in the cigarette and other tobacco products tax rates. Note: This return and payment are
due on or before August 1, 2004. Because August 1 is a Sunday, returns postmarked by August 2, 2004, will be considered
timely. Read all instructions before completing this form.
If you do not have a cigarette or other tobacco product inventory on June 30, 2004, or if you do not sell cigarettes or other
tobacco products, check this box, sign below, and return to the address at the bottom of this form.
CIGARETTES
Inventory of Stamped 20-cigarette Packs
1. Inventory as of June 30, 2004. Number of packs...................................... 1. __________________
2. Multiply the number of packs on line 1 by $0.75 .....................................................................................
2. _____________
Inventory of Stamped 25-cigarette Packs
3. Inventory as of June 30, 2004. Number of packs...................................... 3. __________________
4. Multiply the number of packs on line 3 by $0.9375. ................................................................................
4. _____________
Inventory of Other Quantities of Stamped Cigarettes (computed on a per cigarette basis.)
5. Inventory as of June 30, 2004. Number of cigarettes ............................... 5. __________________
6. Multiply the number of cigarettes on line 5 by $.0375.............................................................................
6. _____________
7. Add lines 2, 4 and 6. ...............................................................................................................................
7. _____________
OTHER TOBACCO PRODUCTS (OTP)
8. Total of wholesale prices of all other tobacco products .........................................................................
8. _____________
(Retailers, vending machine operators and secondary wholesalers: See Instructions)
9. Multiply line 8 by 12% (0.12)...................................................................................................................
9. _____________
10. Add lines 7 and 9 ....................................................................................................................................
10. _____________
I declare under penalty of perjury that the information in this return is true and complete to the best of my knowledge.
Name and Title (Type or Print)
Telephone Number
Signature
Date
Questions: Call the Tobacco Products Inventory Tax Review Unit in the Discovery and Tax Enforcement Division at (517) 636-4120.
Persons who are deaf, hard of hearing or have a speech impairment may call (517) 636-4999 (TTY).
Make checks payable to: "State of Michigan." Write the words "Tobacco Products Inventory Tax" on the front of your check.
Mail check and return to:
Discovery and Tax Enforcement
Michigan Department of Treasury
P.O. Box 30140
Lansing, MI 48909-7640