Hawaii Request for Refund of Unused Cigarette Tax Stamps

Request for Refund of Unused Cigarette Tax Stamps 
Form M-106, Rev 2022, Request for Refund of Unused Cigarette Tax Stamps
Clear Form

FORM M-106
(REV. 2022)

STATE OF HAWAII - DEPARTMENT OF TAXATION

REQUEST FOR REFUND OF UNUSED
CIGARETTE TAX STAMPS

M106_I 2022A 01 VID01

Name of Cigarette Licensee  	
Hawaii Tax I.D. No.:  TO                 
Address  		
	

	

		

City or town	

State	

Postal/Zip Code

Number of unused cigarette tax stamps being returned. . . . . . . . . . . . . . . . . 	
Purchase price per stamp (denominated value of $3.20 less any applied discount) .  .  .  x $ 	
Total amount of refund.  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .   $	
Serial number of the stamps being returned  	
Reason stamps are being returned  	
		

	

	

	

	

	

	

Cigarette and Tobacco Licensee signature	

Print name of signatory	

	

	

	

	

Title

Date

FOR DEPARTMENT OF TAXATION USE ONLY:
Reviewed by Tax Registration		

	

Date

FORM M-106 (REV. 2022)

ID NO 01

FORM M-106
(REV. 2022)	

Page 2

Purpose of Form M-106

Where To File Form M-106

Form M-106 is used to request a refund for unused
cigarette tax stamps.

Submit Form M-106 and the unused cigarette tax stamps
to the following address:
Hawaii Department of Taxation
Tax Registration
P.O. Box 259
Honolulu, HI 96809-0259
After the information has been verified by the Department
of Taxation, the request for refund will be processed.

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.
Enter the information requested on the form. The unused
cigarette tax stamps must be returned to the Department of
Taxation at the time Form M-106 is submitted.
Signature
Form M-106 must be signed and dated by the Cigarette
and Tobacco Licensee.

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