Hawaii Schedule of Imported Foreign Cigarettes to Which Cigarette Tax Stamps Have Been Affixed

Schedule of Imported Foreign Cigarettes to Which Cigarette Tax Stamps Have Been Affixed
Form M-105, Rev 2022, Schedule of Imported Foreign Cigarettes to Which Cigarette Tax Stamps Have Been Affixed
Clear Form
FORM M-105
(REV. 2022)

STATE OF HAWAII - DEPARTMENT OF TAXATION

SCHEDULE OF IMPORTED FOREIGN CIGARETTES
TO WHICH CIGARETTE TAX STAMPS HAVE BEEN AFFIXED
M105_I 2022A 01 VID01

Prepare in triplicate
1- Tax Department
2- Attorney General
3- Your files

Report For the Month of           Year    

1.	 Licensee’s name  		
2.	 Hawaii Tax I.D. No.:  TO                 
3.	 The following items MUST be attached to this schedule:
	
A.	 A copy of a permit issued pursuant to section 5713 of the Internal Revenue Code to the person importing the
		
cigarettes into the United States, permitting the person to import the cigarettes.
	
B.	 A copy of the United States Customs Service form containing, with respect to the cigarettes, the federal tax
		
information required by the United States Bureau of Alcohol, Tobacco and Firearms.
	
	

In the upper right-hand corner of the copies, write the corresponding line reference to identify the cigarettes from the
list below.
No.

Brand

Style

Quantity

Name of Supplier

Name of Customer

1
2
3
4
5
Attach an additional sheet if more space is needed.
As an authorized representative of the licensee, I declare, under penalty of perjury, that I have examined this schedule
and to the best of my knowledge and belief, the information provided is true, correct, accurate and complete.
Signature  	

 Date 	

Print Name  	

 Title 	

As an officer of the manufacturer or importer of the cigarettes listed above, I certify, under penalty of perjury and the
penalties set forth in section 231-36, Hawaii Revised Statutes (HRS), that the manufacturer or importer of cigarettes listed
above has complied with (1) the package health warning and ingredient reporting requirements of the Federal Cigarette
Labeling and Advertising Act, 15 U.S.C. sections 1333 and 1335a, with respect to the cigarettes; and (2) chapter 675,
HRS.
Is the manufacturer a participating manufacturer within the meaning of section 675-3, HRS?   Yes 
(Note: You must check one of these boxes.)
Signature  	

 Date 	

Print Name  	

 Title 	

 No

FORM M-105 (REV. 2022)

ID NO 01

FORM M-105
(REV. 2022)			

Page 2

GENERAL INFORMATION

Signatures

Purpose of Form

Form M-105 must be signed and dated by the Cigarette
and Tobacco Licensee and an officer of the manufacturer or
importer of the cigarettes.

Form M-105 is used to provide documentation of cigarettes
imported into the United States to which a licensee has
affixed a cigarette tax stamp as required under section 24557, Hawaii Revised Statutes (HRS).

ADDITIONAL INFORMATION
Export and Foreign Cigarettes Prohibited
It is unlawful for an entity to possess, keep, store, retain,
transport, sell, or offer to sell, distribute, acquire, hold, own,
import, or cause to be imported into the State any of the
cigarettes described in section 245-51, HRS.

Stamping or Sale of Cigarettes Not Listed in
the Directory Prohibited
Unless the cigarette package is exempt under section 2453(b), HRS, it is unlawful (a) to affix a cigarette tax stamp to
any cigarette package whose tobacco product manufacturer
or brand family is not listed in the directory established under
chapter 486P, HRS, or (b) to import, sell, offer, keep, store,
acquire, transport, distribute, receive, or possess for sale
or distribution cigarettes of a tobacco product manufacturer
or brand family not included in the directory. Any entity in
violation will be guilty of a class C felony.
To determine whether the cigarette manufacturer or brand
family is listed in such directory, please visit the Tobacco
Enforcement Unit, Department of the Attorney General’s
website at: ag.hawaii.gov/cjd/tobacco-enforcement-unit.
The Tobacco Enforcement Unit also may be contacted as
follows:
Correspondence:
TOBACCO ENFORCEMENT UNIT
Department of the Attorney General
425 Queen Street
Honolulu, Hawaii 96813
Telephone: (808) 586-1203

SPECIFIC INSTRUCTIONS
Fill this form out completely. In the Name of Customer
column of the table, you must identify the person or persons,
if any, to whom the cigarettes have been conveyed for resale.
Attach a separate sheet if more space is needed.

When and Where to File
File this form on the first business day of the month
following the month in which a Hawaii cigarette tax stamp
has been affixed to cigarettes imported into the United
States. If this date falls on a Saturday, Sunday, or holiday,
file this form on the next business day. Do not file this form
with your Hawaii Cigarette and Tobacco Products Monthly
Tax Return.
Mail two copies of Form M-105, with attachments, to the
following address:
Hawaii Department of Taxation
Tax Registration
P.O. Box 259
Honolulu, HI 96809-0259
The Department of Taxation will forward one of the copies
to the Department of the Attorney General.

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