Form 4032 (Schedule L) - Tax-Free Tobacco Products Sold To Michigan Tribes

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Michigan Department of Treasury

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4032 (7-03)

Schedule L - Tax-Free Tobacco Products Sold to Michigan Tribes

Name of Licensee

FE, ME or TR Number

Year

Month of Return

To be eligible to receive tax-free tobacco a tribe must first enter into an agreement with the State of Michigan in which the tribe designates a single

licensee to provide the tribe tax-free tobacco products. The license will receive written authorization from the Department of Treasury verifying the

designation, identifying the amount of tax-free quota and the effective beginning date of such treatment.

Copies of all invoices must be attached. Failure to provide this information and documentation will result in this deduction being disallowed and an

assessment being issued for the additional tax, penalty, and interest due in accordance with Public Act 122 of 1941.

Number of Cigarettes

Invoice

Treasury Identifier

Name and Address of Tribe the Tobacco

Wholesale Price of OTP

(Not packs, cartons or cases)

Date

Number