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Hawaii Free Printable Form M-104, Rev 2019, Export Exemption Certificate for Cigarette and Tobacco Taxes for 2020 Hawaii Export Exemption Certificate for Cigarette and Tobacco Taxes

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Export Exemption Certificate for Cigarette and Tobacco Taxes
Form M-104, Rev 2019, Export Exemption Certificate for Cigarette and Tobacco Taxes

Clear Form STATE OF HAWAII — DEPARTMENT OF TAXATION FORM M-104 (Rev. 2019) PART I EXPORT EXEMPTION CERTIFICATE FOR CIGARETTE AND TOBACCO TAXES Information About the Cigarette and Tobacco Licensee PART II Information About the Purchaser, Consumer, or User Name Name Address Address City or town City or town State Postal/Zip Code State Postal/Zip Code Type of organization (e.g., Corporation, Partnership, Individual, etc.) Type of organization (e.g., Corporation, Partnership, Individual, etc.) Hawaii Tax I.D. No.: TO                  PART III Cigarettes or Tobacco Products Included in Transaction A. Description of cigarettes or tobacco products  B. Value of cigarettes or tobacco products or gross proceeds involved  C. Number of cigarettes involved CERTIFICATION BY CIGARETTE AND TOBACCO LICENSEE; AND PURCHASER, CONSUMER, OR USER The undersigned Cigarette and Tobacco Licensee; and purchaser, consumer, or user hereby certify, pursuant to sections 231-36 and 245-32, Hawaii Revised Statutes (HRS), as amended, and section 18-245-6, Hawaii Administrative Rules, relating to export exemption and certification: (1) that the information provided in Parts I, II, and III above are true and correct; (2) that until this certificate is revoked by notice in writing by either of the parties who signed the certificate or the Department of Taxation, it shall apply to this order or contract of sale between the Cigarette and Tobacco Licensee; and the purchaser, consumer, or user; and (3) that for the sale of cigarettes, the cigarette tax stamps were placed upon the cigarette packages. The Cigarette and Tobacco Licensee certifies that he/she will remit the tax due on the sale of the tobacco products, or will not request a refund of the cigarette tax paid with cigarette tax stamps, as imposed by Chapter 245, HRS, to the Department of Taxation if: (1) the place of delivery of the cigarettes or tobacco products for which the export exemption was claimed is not outside the State; (2) the cigarettes or tobacco products were not shipped or transmitted by the Cigarette and Tobacco Licensee to the purchaser at a place of delivery outside the State; or (3) the cigarettes or tobacco products were not resold, consumed, or used outside the State. Cigarette and Tobacco Licensee signature Print name of signatory Purchaser, consumer, or user signature Title Date Print name of signatory Title Date FORM M-104 M104_I 2019A 01 VID01 ID NO 01 FORM M-104 INSTRUCTIONS (Rev. 2019) GENERAL INFORMATION Section 245-32, Hawaii Revised Statutes (HRS), provides for a cigarette and tobacco tax refund or credit to a licensee who has paid a cigarette or tobacco tax on the distribution of cigarettes or tobacco products that are shipped to a point outside the State for subsequent sale or use outside the State. 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 245-3(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 PURPOSE OF THIS CERTIFICATE Form M-104, Export Exemption Certificate for Cigarette and Tobacco Taxes, must be completed in order for the Cigarette and Tobacco Licensee to claim a (1) cigarette tax refund, or (2) tobacco tax exemption on the distribution of cigarettes or tobacco products that are shipped to a point outside the State for subsequent sale or use outside the State. Form M-104 must also be completed for sales made under section 212-8, HRS, to any common carrier for consumption out-of-state by the crew or passengers on such carrier, and for sales by wholesalers from U.S. licensed bonded warehouses to foreign fishing vessels and to common carriers for out-of-state consumption by the crew or passengers. This form must be a part of each order or contract of sale between the Cigarette and Tobacco Licensee; and purchaser, consumer, or user who are signatories to the certificate. In the event Form M-104 is impracticable to complete, an alternative form or document may be used provided the information requested in Parts I, II, and III of Form M-104 are maintained. SPECIFIC INSTRUCTIONS Part I Enter information regarding the Cigarette and Tobacco Licensee. Part II Enter information regarding the purchaser, consumer, or user. Part III Enter information regarding the cigarettes or tobacco products involved in this transaction. SIGNING OF THE CERTIFICATE The certificate shall be dated, executed, and signed by both the Cigarette and Tobacco Licensee; and the purchaser, consumer, or user. WHERE TO FILE THE CERTIFICATE The certificate must be attached to the Cigarette and Tobacco Licensee’s Form M-19, Cigarette and Tobacco Products Monthly Tax Return, when claiming a refund of cigarette taxes paid with cigarette tax stamps. The certificate does not need to be attached to Form M-19 when claiming a tobacco tax exemption. Instead, the certificate must be retained at the Cigarette and Tobacco Licensee’s place of business. 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
Extracted from PDF file 2019-hawaii-form-m-104.pdf, last modified June 2003

More about the Hawaii Form M-104 Other TY 2019

We last updated the Export Exemption Certificate for Cigarette and Tobacco Taxes in March 2020, so this is the latest version of Form M-104, fully updated for tax year 2019. You can download or print current or past-year PDFs of Form M-104 directly from TaxFormFinder. You can print other Hawaii tax forms here.

Other Hawaii Other Forms:

TaxFormFinder has an additional 164 Hawaii income tax forms that you may need, plus all federal income tax forms.

Form Code Form Name
Form HW-4 Employee's Withholding Exemption and Status Certificate
Form HW-6 Employee's Statement to Employer Concerning Nonresidence in the State of Hawaii
Form L-80 Tracer Request For Tax Year ______
Form ITPS-COA Change of Address
Form HW-14 Periodic Withholding Tax Return

Download all HI tax forms View all 165 Hawaii Income Tax Forms


Form Sources:

Hawaii usually releases forms for the current tax year between January and April. We last updated Hawaii Form M-104 from the Department of Taxation in March 2020.

Show Sources >

Historical Past-Year Versions of Hawaii Form M-104

We have a total of five past-year versions of Form M-104 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:


2019 Form M-104

Form M-104, Rev 2019, Export Exemption Certificate for Cigarette and Tobacco Taxes

2018 Form M-104

Form M-104, Rev 2013, Export Exemption Certificate for Cigarette and Tobacco Taxes

2017 Form M-104

Form M-104, Rev 2013, Export Exemption Certificate for Cigarette and Tobacco Taxes

2016 Form M-104

Form M-104, Rev 2013, Export Exemption Certificate for Cigarette and Tobacco Taxes

Forms 2013 2015 Form M-104

Form M-104, Rev 2013, Export Exemption Certificate for Cigarette and Tobacco Taxes


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