Form 4256 - T-108 Schedule Of Other Tobacco Products Sales (Disbursements)
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1
2Michigan Department of Treasury
4256 (Rev. 01-13)
T-108: Schedule of Other Tobacco Products Sales (Disbursements)
Important: Read the instructions on Page 2 before completing this schedule.
1. Name
2. Account Number (FEIN, ME or TR Number)
3. Michigan License Number
4. Reporting Period (MM/CCYY)
SCHEDULE TYPES:
CHECK ONE box below to identify what is itemized on this schedule. Do not combine schedule types or product codes.
T-108a: Schedule of Untaxed Other Tobacco Product Sales in Michigan to Licensed Wholesalers (Out-of-State Unclassified Acquirers Only)
T-108b: Schedule of Other Tobacco Product Sales in Michigan from tax-unpaid inventory
T-108c: Schedule of Other Tobacco Product Sales from Tax Paid Inventory
T-108d: Schedule of Other Tobacco Product Sales in Michigan to U.S. Agencies
NPM Roll-Your-Won (RYO) Tobacco Products
20. Total
Sold to Information
Address of Purchaser
Manufactuer
Brand
14.
19. Total
5. Date
6. Invoice
7. Invoice
8. Branch
Premium
Whole-
Ounces per
Sold
Date
Number
Code
Cigar Stick
sale Price
Entry
9. FEIN
10. Name
11. Type
12. City
13. State
15. FEIN
16. Name
17. Code
18. Name
Count (PC1)
22. TOTAL
23. TOTAL
21. TOTAL
$
ounces
PC1’S
Attach to your Michigan WT-100, AT-100, and ST-100 forms.
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