Form M-100B "Authorization to Order and Receive Cigarette Tax Stamps" - Hawaii

What Is Form M-100B?

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, 2010;
  • 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 printable version of Form M-100B 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-100B "Authorization to Order and Receive Cigarette Tax Stamps" - Hawaii

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FORM M-100B
STATE OF HAWAII — DEPARTMENT OF TAXATION
(REV. 2010)
AUTHORIZATION TO ORDER AND
RECEIVE CIGARETTE TAX STAMPS
Mail this completed form to: Department of Taxation, Taxpayer Services Branch, P.O. Box 259, Honolulu, HI 96809-0259
To correct, add, or delete names, please file a new Form M-100B
PURCHASER MUST COMPLETE THIS FORM FOR EACH
PICK UP LOCATION
Part I - Licensee Information
Name ____________________________________________________ Branch/Location
________
Cigarette Tax and Tobacco Tax License Number
Hawaii Tax Identification Number: W __ __ __ __ __ __ __ __ - __ __
Part II - Contact Information - Provide all requested information.
Primary contact:
Name:
Telephone:
Fax:
E-mail address:
Secondary Contact:
Name:
Telephone:
Fax:
E-mail address:
Part III - Pick Up Location
For the island of ________________. Pick up at First Hawaiian Bank ______________________________ Branch.
(Available at all Oahu branches and at the Lihue, Kahului, Lahaina, Hilo, and Kona branches.)
~ CONTINUED ON BACK OF FORM ~
DEPARTMENT OF TAXATION USE ONLY
APPROVED BY:
Signature
Date
Print Name of Signatory
Title
FORM M-100B
FORM M-100B
STATE OF HAWAII — DEPARTMENT OF TAXATION
(REV. 2010)
AUTHORIZATION TO ORDER AND
RECEIVE CIGARETTE TAX STAMPS
Mail this completed form to: Department of Taxation, Taxpayer Services Branch, P.O. Box 259, Honolulu, HI 96809-0259
To correct, add, or delete names, please file a new Form M-100B
PURCHASER MUST COMPLETE THIS FORM FOR EACH
PICK UP LOCATION
Part I - Licensee Information
Name ____________________________________________________ Branch/Location
________
Cigarette Tax and Tobacco Tax License Number
Hawaii Tax Identification Number: W __ __ __ __ __ __ __ __ - __ __
Part II - Contact Information - Provide all requested information.
Primary contact:
Name:
Telephone:
Fax:
E-mail address:
Secondary Contact:
Name:
Telephone:
Fax:
E-mail address:
Part III - Pick Up Location
For the island of ________________. Pick up at First Hawaiian Bank ______________________________ Branch.
(Available at all Oahu branches and at the Lihue, Kahului, Lahaina, Hilo, and Kona branches.)
~ CONTINUED ON BACK OF FORM ~
DEPARTMENT OF TAXATION USE ONLY
APPROVED BY:
Signature
Date
Print Name of Signatory
Title
FORM M-100B
FORM M-100B
(REV. 2010)
Licensee Name ______________________________________ Branch/Location__________________
Cigarette Tax and Tobacco Tax License Number _________
Hawaii Tax Identification Number: W __ __ __ __ __ __ __ __ - __ __
Part IV - Persons Authorized to Order and Receive Hawaii Cigarette Tax Stamps
Signatures must be original. Photocopies or faxes will not be accepted.
Number of people listed below
Printed Name
Signature
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
To correct, add, or delete names, please file a new Form M-100B.
I declare, under the penalties set forth in section 231-36, HRS, that the information contained above has been examined by me
and, to the best of my knowledge and belief, is true and correct. I further declare that the individuals listed in Part IV above are
authorized to order and receive Hawaii Cigarette Tax Stamps on behalf of the licensee and I further acknowledge and agree
that the receipt of said stamps by any of these authorized individuals shall constitute a waiver and release of any and all claims
of liability against the State of Hawaii for the loss or theft of said stamps.
Signature of Owner, Partner, Member, or Principal Corporate Officer
Print Name of Signatory
Title
Date
FORM M-100B
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