Form 805 - Reservation Retailer'S Monthly Report Page 2

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AZ FORM 805
PAGE 2
GENERAL INSTRUCTIONS
SPECIFIC INSTRUCTIONS
You must file this report if you are a registered retailer on
Line 1: Enter the total number of packs of cigarettes sold in the
reservation selling cigarettes in the state of Arizona.
month.
You must file this report monthly on or before the 20th day
Line 2. Enter the number of packs of cigarettes that were sold
after the month the sales were made.
Line 3. Enter the total dollar amount of sales of other tobacco
Prepare this report for each month regardless of whether or
products in the month.
not any sales were made. File the original with the Department
of Revenue. Retain a copy of the return with all substantiating
Line 4. Enter the percentage of sales of other tobacco
documentation for at least four years, subject to inspection by
products to enrolled members of the tribe in the month.
the Department.
You must provide your registration number.
You must provide your identification number on the form. An
identification
number
is
either
your
federal
employer
The holder of the Registration or Authorized Agent must sign
ADOR 20-2043 (12/94)

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