Hawaii Transfer of Cigarette Tax Stamps

Transfer of Cigarette Tax Stamps
Form M-103, Rev 2022, Transfer of Cigarette Tax Stamps
Clear Form

FORM M-103
(REV. 2022)

STATE OF HAWAII - DEPARTMENT OF TAXATION

TRANSFER OF CIGARETTE TAX STAMPS
M103_I 2022A 01 VID01

PART I	

Information About the Licensee Transferring the Cigarette Tax Stamps

Name  		
Hawaii Tax I.D. No.:  TO                 
Address  		
	
	
		

City or town	

State	

Postal/Zip Code

PART II	 Information About the Licensee Receiving the Cigarette Tax Stamps
Name  		
Hawaii Tax I.D. No.:  TO                 
Address  		
	
	
		

City or town	

State	

Postal/Zip Code

PART III	 Transfer of Cigarette Tax Stamps
A.	 Serial number of the stamps being transferred  				
B.	 Number of stamps being transferred  	

	

C.	 Multiply amount from line B, Part III, by $3.20  	

D.	 Reason for the transfer  				
	

				

	

	

	

	

	

	

	

	

Signature of Licensee Transferring the Cigarette Tax Stamps	

Print Name of Signatory	

	

	

	

	

	

	

Signature of Licensee Receiving the Cigarette Tax Stamps

Print Name of Signatory

          Title            Date                   Title            Date

FOR OFFICIAL USE ONLY:

 Transfer of Cigarette Tax Stamps Approved
 Transfer of Cigarette Tax Stamps Disapproved

	
	
			

Signature 
	

			

Title 
	

THIS SPACE FOR DATE RECEIVED STAMP		Date 
	

ID NO 01

FORM M-103 (REV. 2022)

FORM M-103
(REV. 2022)	

Page 2

Purpose of Form M-103

Where To File Form M-103

Licensees may not sell, exchange, or transfer unaffixed
cigarette tax stamps without prior written approval by the
Department of Taxation. Form M-103 is used to request
approval for the transfer of the cigarette tax stamps.

Mail Form M-103 to the following address:
Hawaii Department of Taxation
Tax Registration
P.O. Box 259
Honolulu, HI 96809-0259
After the form has been approved or disapproved, a
copy will be returned to both the licensee transferring the
cigarette tax stamps and the licensee receiving the cigarette
tax stamps.

GENERAL INSTRUCTIONS
Sections 245-21 and 245-22, Hawaii Revised Statutes
(HRS), provide that licensees, as defined in section 245-1,
HRS, shall pay the cigarette tax through the use of cigarette
tax stamps and that licensees are required to place cigarette
tax stamps on packs of cigarettes prior to distribution, as
defined in section 245-1, HRS.

SPECIFIC INSTRUCTIONS
Part I
Enter information regarding the licensee transferring the
cigarette tax stamps.

Part II
Enter information regarding the licensee receiving the
cigarette tax stamps.

Part III
Enter information regarding the cigarette tax stamps
being transferred.

Signatures
Form M-103 must be signed and dated by the licensee
transferring the cigarette tax stamps and the licensee
receiving the cigarette tax stamps.

Where To Get Forms, Instructions, and
Publications
Forms, publications, and other documents, such as
copies of Tax Information Releases and Administrative Rules
issued by the Department, are available on the Department’s
website at tax.hawaii.gov or you may contact a customer
service representative at:
Voice:	 808-587-4242
	
1-800-222-3229 (Toll-Free)
Telephone for the Hearing Impaired:
	
808-587-1418
	
1-800-887-8974 (Toll-Free)
Fax:	 808-587-1488
Mail:	 Taxpayer Services Branch
	
P. O. Box 259
	
Honolulu, HI 96809-0259