Form 323 - Application For Non-Cigarette Tobacco Products Stamp

Download a blank fillable Form 323 - Application For Non-Cigarette Tobacco Products Stamp in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 323 - Application For Non-Cigarette Tobacco Products Stamp with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

Michigan Department of Treasury

Reset Form

323 (Rev. 08-13)

Application for Non-Cigarette Tobacco Products Stamp

Issued under the authority of P.A. 327 of 1993, as amended. Filing is mandatory. You will not receive a stamp unless this form is filed.

Treasury will approve your application and send it to the stamp manufacturer approved by the department. The manufacturer will deliver

the stamp to you. Please pay the manufacturer directly. Do not order a new or replacement stamp directly from the manufacturer.

Your request must be approved before the stamp can be made.

PART 1: APPLICANT NAME AND ADDRESS

Name of Owner or Trade name

FE, ME or TR Number

Corporate Office Street Address

State

City

ZIP Code

Quantity of Stamps Requested

Reason for Stamp Order:

Replace Stamp (Please select only if a previously issued stamp has been lost or damaged)

Damaged Stamp*

Lost Stamp**

New Stamp (Select only if no OTP stamp has been issued previously)

*Damaged stamps are required to be returned to the Department.

**Please note that by selecting “Lost Stamp” and signing this form you are certifying that all reasonable efforts to locate the stamp have been exhausted.

This certification will be placed on file.

Owner’s Signature

Owner’s Printed Name

Daytime Phone Number

PART 2: SHIPPING ADDRESS

Provide shipping address where the stamp is to be delivered.

PART 3: MICHIGAN DEPARTMENT OF TREASURY APPROVAL

Stamp Number to be inserted in Seal

Treasury Authorizing Signature

PART 4: MANUFACTURER ENDORSEMENT

Manufacturer Signature

A stamp(s) as described above was delivered to the applicant on (date)