Arizona Form 841 - Cigarette Distributor'S Monthly Report Of Cigarettes Received In Packages Of Other Than Packages Of 20 Or 25 Cigarettes Page 3

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AZ Form 841 Page 3 of 4
Schedule C
Out-of-State Sale of Cigarettes in Packages of Other Than 20 or 25 Cigarettes During The Month
Sold to:
INVOICE
DATE
NO. OF
NAME OF PURCHASER
CITY
STATE
SHIPPED
CIGARETTES
DATE
NUMBER
Total this sheet ................................................................................................................................................................
Total all sheets ................................................................................................................................................................
Total this month: Enter here and on page 1, line 2j........................................................................................................
Schedule D
Credit for Unsaleable Cigarettes in Packages of
Other Than 20 or 25 Cigarettes
Returned to Suppliers During the Month
INVOICE
DATE
NO. OF
RETURN TO
CITY
STATE
SHIPPED
CIGARETTES
DATE
NUMBER
Total this sheet ................................................................................................................................................................
Total all sheets ................................................................................................................................................................
Total this month: Enter here and on page 1, line 2k.......................................................................................................
ADOR 14-2026 (11/02)

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