Fillable Form 336 - Tobacco Tax License Application (Page 6 of 7) in pdf

Form 336 Page 6

PArT 8: CiGAreTTe mAKinG mACHines/roLLinG mACHines/meCHAniCAL DeViCes

MCL 205.422(b) defines a “cigarette making machine” as any machine or other mechanical device which meets all of the

following criteria:

• Is capable of being loaded with loose tobacco, cigarettes tubes or cigarette papers, and any other components related to the

production of cigarettes;

• Is designed to automatically or mechanically produce, roll, fill, dispense, or otherwise generate cigarettes;

• Is commercial-grade or otherwise designed or suitable for commercial use; and

• Is designed to be powered or operated by a main or primary source other than human power.

CiGAreTTe mAKinG mACHines:

A. Does the business currently own or lease a CIGARETTE MAKING MACHINE?........................................................

Yes

If YES, please provide the address where the machine is located.

Address

B. Is there currently or will there be at least one CIGARETTE MAKING MACHINE operated at the

above business address to produce, roll or otherwise generate cigarettes? ...............................................................

Yes

If YES, please indicate the number of CIGARETTE MAKING MACHINES currently operated

at the above location (indicate zero if none currently operate):________________

oTHer roLLinG mACHines or meCHAniCAL DeViCes:

A. Is there currently or will there be at least one machine or other mechanical device (which is not a CIGARETTE

MAKING MACHINE) available for use by customers or others at the above business address for the purpose

of producing, rolling or otherwise generating cigarettes? ............................................................................................

Yes

If YES, please indicate the number of machines or other mechanical devices (which are not CIGARETTE

MAKING MACHINES) currently operated at the above address: __________

Address

If YES, check ALL of the following that apply which best describes how the machine(s) or mechanical device(s) are powered in order to

operate:

Manual/Hand Crank

Electric (Plug-In)

Battery Operated

PArT 9: CerTifiCATion

eACH and eVerY business owner, officer, partner, member, and persons authorized to make decisions for this company listed in Part

2 must sign this application.

IN SIGNING THIS APPLICATION, I AGREE to comply with the provisions of the Tobacco Products Tax Act, 1993 PA 327. I declare

UNDER PENALTY OF PERJURY that I have examined the information on this application, including any accompanying statements

or attachments, and that, to the best of my knowledge, it is true and complete. I authorize the Michigan Department of Treasury to fax

confidential tax information of the business to the fax number provided on this application. I recognize that faxing is not a secure means

of transmission and I assume all risks involved.

Signature

Printed Name

Title

Date

Signature

Printed Name

Title

Date

Signature

Printed Name

Title

Date

Signature

Printed Name

Title

Date

Form 336 - Tobacco Tax License Application Page 6

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