Form M-100A "Application to Purchase Cigarette Tax Stamps" - Hawaii

What Is Form M-100A?

This is a legal form that was released by the Hawaii Department of Taxation - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the Hawaii Department of Taxation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form M-100A by clicking the link below or browse more documents and templates provided by the Hawaii Department of Taxation.

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Download Form M-100A "Application to Purchase Cigarette Tax Stamps" - Hawaii

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Clear Form
STATE OF HAWAII — DEPARTMENT OF TAXATION
FORM M-100A
(REV. 2013)
APPLICATION TO PURCHASE CIGARETTE TAX STAMPS
Initial Application
Amended Application (This supercedes all previous applications.)
Information About the Licensee
Cigarette Tax and Tobacco Tax License Number ______
Name
DBA
Check one:
Wholesaler
Type of organization (e.g. Corporation, Partnership, Individual, etc.)
Dealer
Hawaii Tax Identification
Number: W __ __ __ __ __ __ __ __ - __ __
Address
SSN/FEIN:
Telephone number:
______________________
City or town
State
Postal/ZIP Code
List the owners, partners, members, or principal corporate officers (Attach additional sheet if needed) Please print.
SSN/FEIN
Title
Address
Phone No.
Name
I declare, under the penalties set forth in section 231-36, HRS, that the information contained in this application has been
examined by me and, to the best of my knowledge and belief, is true and correct.
Signature of Owner, Partner, Member, or Principal Corporate Officer
Date
Print Name of Signatory
Title
DEPARTMENT OF TAXATION USE ONLY
Upon approval, the above named licensee is authorized to purchase Hawaii Cigarette Tax Stamps.
APPROVED BY ________________________ Approval Number CIG-
FORM M-100A
Clear Form
STATE OF HAWAII — DEPARTMENT OF TAXATION
FORM M-100A
(REV. 2013)
APPLICATION TO PURCHASE CIGARETTE TAX STAMPS
Initial Application
Amended Application (This supercedes all previous applications.)
Information About the Licensee
Cigarette Tax and Tobacco Tax License Number ______
Name
DBA
Check one:
Wholesaler
Type of organization (e.g. Corporation, Partnership, Individual, etc.)
Dealer
Hawaii Tax Identification
Number: W __ __ __ __ __ __ __ __ - __ __
Address
SSN/FEIN:
Telephone number:
______________________
City or town
State
Postal/ZIP Code
List the owners, partners, members, or principal corporate officers (Attach additional sheet if needed) Please print.
SSN/FEIN
Title
Address
Phone No.
Name
I declare, under the penalties set forth in section 231-36, HRS, that the information contained in this application has been
examined by me and, to the best of my knowledge and belief, is true and correct.
Signature of Owner, Partner, Member, or Principal Corporate Officer
Date
Print Name of Signatory
Title
DEPARTMENT OF TAXATION USE ONLY
Upon approval, the above named licensee is authorized to purchase Hawaii Cigarette Tax Stamps.
APPROVED BY ________________________ Approval Number CIG-
FORM M-100A
FORM M-100A
(REV. 2013)
Page 2
Purpose of Form M-100A
Where to Get Information and Forms
Form M-100A is used to apply to purchase cigarette tax
Oahu District Office
Maui District Office
stamps.
830 Punchbowl Street
54 S. High St., #208
GENERAL INSTRUCTIONS
P. O. Box 259
Wailuku, HI 96793-2198
Honolulu, HI 96809-0259
Toll-Free: 1-800-222-3229
Sections 245-21 and 245-22, Hawaii Revised Statutes (HRS),
Tel. No.: (808) 587-4242
provide that licensees, as defined in section 245-1, HRS, shall
Toll-Free: 1-800-222-3229
pay the cigarette tax through the use of cigarette tax stamps
For the hearing impaired:
and that licensees are required to place cigarette tax stamps on
Tel. No.: (808) 587-1418
packs of cigarettes prior to distribution, as defined in section
Toll-Free: 1-800-887-8974
245-1, HRS.
Hawaii District Office
Kauai District Office
Under section 245-22(e), HRS, the price of cigarette tax stamps
may be reduced by a certain rate if the licensee is in compliance
75 Aupuni Street, #101
3060 Eiwa St., #105
with the State of Hawaii’s tax laws. To demonstrate compliance
Hilo, HI 96720-4245
Lihue, HI 96766-1889
with the State of Hawaii’s tax laws and thus be eligible for the
Toll-Free: 1-800-222-3229
Toll-Free: 1-800-222-3229
reduced cigarette tax stamp price, a tax clearance certificate
Tax information and forms:
(Form A-6, Tax Clearance Application) with the State of Hawaii’s
tax.hawaii.gov
approval must be submitted to the Department of Taxation.
Where to submit Form M-100A
If the licensee has a tax clearance certificate with the State of
Hawaii’s approval dated within six months from the date of
Mail Form M-100A to the following address:
submitting Form M-100A to the Department of Taxation, the
Hawaii Department of Taxation
licensee may submit a copy of that certificate in lieu of a
Licensing Section
completed Form A-6. Otherwise, the licensee shall complete
P.O. Box 259
and submit Form A-6 along with Form M-100A.
Honolulu, HI 96809-0259
Signature
Form M-100A must be signed and dated by the cigarette tax
and tobacco tax licensee.
FORM M-100A
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