Form 841 - Department Of Revenue Tobacco Tax Section Page 4
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4GENERAL INSTRUCTIONS
Line 1d through f. Enter the number of packages of the different number
You must file this return and pay the luxury tax if you are a distributor of
of cigarettes per pack and multiply by that number. Enter the actual
cigarettes in packages of other than 20 or 25 cigarettes within the state of
number of cigarettes on line 1(d) through 1(f).
Arizona.
Line 1A. Add lines 1(a) through 1(f). Enter the total cigarettes received.
You must file this return monthly and pay the tax on or before the 20th day
after the month the tax accrues.
Line 2g. On Schedule A, enter any tax free sales to your customers on the
Indian reservation during the month. The sale must be in the ratios
Prepare this return for each month regardless of whether or not any tax is
provided to you by the Department. Enter the totals from Schedule A on
due. File the original with the Department of Revenue. Retain a copy of
line 2(g), page 1. You may substitute a computer generated list for the
the return with all substantiating documentation for at least four years,
actual schedule.
subject to inspection by the Department.
Line 2h. On Schedule B, enter any sales to your customers on the Indian
You must provide your tobacco license number.
reservation at the rate indicated in § 42-1241 during the month. The sale
must be in the ratios provided to you by the Department. Enter the totals
You must provide your taxpayer identification number on the form. A
from Schedule B on line 2(h), page 1. You may substitute a computer
taxpayer identification number is either your federal employer identification
generated list for the actual schedule.
number (EIN), or your social security number (SSN), if you are a sole
proprietor, with no employees.
Line 2i. On Schedule C, enter any sales made out of state during the
month. Enter the totals from Schedule C on line 2(i), page 1. You may
The Licensee or Authorized Agent must sign the form.
If you pay a preparer to complete this return, the preparer must sign the
Line 2j. On Schedule D, enter any product returned to suppliers during the
month. Enter the totals from Schedule D on line 2(j), page 1. You may
Send payment with the return to the Arizona Department of Revenue.
substitute a computer generated list for the actual schedule.
Include your taxpayer identification number on your check.
Line 2B. Add lines 2(g) through 2(j). Enter the total here.
State law imposes a 10% penalty plus interest of the amount of tax due on
each return if your payment is late. State law imposes a 5% penalty per
Line 3. Subtract line 2B from 1A. Enter the total here.
month if you fail to file. The combined penalties, however, cannot exceed
25%.
Line 4a. Enter the number of taxable cigarettes from line 3 and multiply by
the rate per cigarette of $0.029. Enter the tax due.
SPECIFIC INSTRUCTIONS
Line 4b. Enter the number of cigarettes from line 2(h) and multiply by the
Line 1a. Enter the number of packages of 10 cigarettes per pack and
rate per cigarette of $0.02. Enter the tax due.
multiply by 10. Enter the actual number of cigarettes on line 1(a).
Line 5. Add lines 4a and 4b to arrive at the total taxable cigarettes and the
Line 1b. Enter the number of packages of 12 cigarettes per pack and
total tax due.
multiply by 12. Enter the actual number of cigarettes on line 1(b).
Line 1c. Enter the number of packages of 16 cigarettes per pack and
ADOR 20-2026 (12/94)
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