Form 841 - Department Of Revenue Tobacco Tax Section Page 3

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AZ Form 841
PAGE 3
SCHEDULE C
Sale of cigarettes in packages of other than 20 or 25 cigarettes out-of-state during the month
Date
Invoice
Number of
Name of Purchaser
City
State
Shipped
Cigarettes
Date
Number
Total this sheet
Total all sheets
Total this month. Enter here and on line i. , page 1
SCHEDULE D
Credit for unsaleable cigarettes in packages of other than 20 or 25 cigarettes returned to suppliers during the month
Date
Invoice
Number of
Return To
City
State
Shipped
Cigarettes
Date
Number
Total this sheet
Total all sheets
Total this month. Enter here and on line 2 j. , page 1
ADOR 20-2026 (12/94)

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