Form 800 Nr - Cigarette Distributor'S Monthly Report
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1
2LUXURY TAX
ARIZONA FORM
COMPTROLLER SECTION
800 NR
ARIZONA DEPARTMENT OF REVENUE
Luxury Tax, Rm 610
1600 W Monroe
Phoenix AZ 85007
CIGARETTE DISTRIBUTOR'S MONTHLY REPORT
(For Non-resident Licensed Distributors)
For the Month of ________________________________________ 19 _____
This return must be filed with the Department of Revenue not
later than the 20th day of the 1st month following the month for
Licensed Distributor - Name
Tobacco License No
Taxpayer ID (EIN or SSN)
Address - Mailing
Address - Business Location
City
State
Zip Code
City
State
Zip Code
READ INSTRUCTIONS ON REVERSE
PART I: CIGARETTE
Blue Stamps
Section A:
Taxable Regular
(Blue Tax Stamps @ $0.58 for 20's and $.725 for 25's)
20's
25's
1. Stamped packages for sale in Arizona on hand -- beginning of month
2. Add: Packages stamped during month - for sale in Arizona
3. Ending Inventory: Stamped packages - for sale in Arizona -- end of month
4. Taxable Distribution: Stamped packages delivered in Arizona
Red Stamps
Section B:
Taxable Reservation
(Red Tax Stamps @ $0.40 for 20's and $0.50 for 25's)
20's
25's
1. Stamped packages for sale in Arizona on hand -- beginning of month
2. Add: Packages stamped during month - for sale in Arizona
3. Ending Inventory: Stamped packages - for sale in Arizona -- end of month
4. Taxable Distribution: Stamped packages delivered in Arizona
(Attach Schedule 800-NR-C)
Green Stamps
Section C:
Tax Free Reservation
(Green Tax Stamps @ No $ Value)
20's
25's
1. Stamped packages for sale in Arizona on hand -- beginning of month
2. Add: Packages stamped during month - for sale in Arizona
3. Ending Inventory: Stamped packages - for sale in Arizona -- end of month
4. Taxable Distribution: Stamped packages delivered in Arizona
(Attach Schedule 800-NR-C)
PART 2: STAMP INVENTORY
Blue
Red
Green
20's
25's
20's
25's
20's
25's
1. Arizona stamps on hand -- beginning of month
2. Add: Arizona stamps purchased during
3. Less: Arizona stamps on hand -- end of month
4. Arizona stamps affixed during month ***
*** If line 4 does not equal to information reported on line A-2, B-2 and C-2 in Part 1, attach explanation of difference to the back of this report.
Declaration of preparer (other than taxpayer) is based on all information of
I have read this claim and any attachments with it. Under penalties of purjury, I
which preparer has any knowledge.
declare that to the best of my knowledge and belief, they are correct and
Preparer's Signature
Taxpayer's Authorized Agent's Aignature
Preparer's TIN
Title
ADOR 20-2013 (3/95)
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