Arizona Form 800-25 - Cigarette Distributor'S Monthly Return - Arizona Department Of Revenue
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12Cigarette Distributor’s Monthly Return
ARIZONA FORM
Luxury
800-25
Tax
This return must be fi led with the Arizona Department of Revenue not later than
the 20th day of the 1st month following the month for which this return is made.
FOR THE MONTH OF (enter full month and 4-digit year)
TOBACCO LICENSE NO.
TAXPAYER ID (EIN OR SSN)
MONTH YYYY
LEGAL BUSINESS NAME
BUSINESS (OR DBA) NAME
MAILING ADDRESS
ADDRESS OF BUSINESS LOCATION
Check if new.
Check if new.
CITY
STATE
ZIP
CITY
STATE
ZIP
NAME OF CONTACT PERSON
TELEPHONE NUMBER WITH AREA CODE
Check if new.
Check if new.
E-MAIL ADDRESS
FAX NUMBER WITH AREA CODE
Check if new.
Check if new.
Read instructions beginning on page 10.
Packages of 25
U
C
I
NSTAMPED
IGARETTE
NVENTORY
1. Beginning inventory - unstamped packages .......................................................................................................
2. Additions: Received during month (Schedule A1, A2 and Schedule E) .............................................................
3. Total unstamped packages .................................................................................................................................
4. Deductions:
a. Unstamped product exported from state (Schedule C-1 and/or Schedule C-2) ............................................
b. Stamped other states (stamped inventory below or Schedule C-1 and/or Schedule C-2).............................
c. Ending inventory - unstamped packages .......................................................................................................
5. Total deductions: Add lines 4a, 4b and 4c .........................................................................................................
6. Total packages required to be Arizona stamped .................................................................................................
S
I
(A
)
Blue ($1.475)
Red ($1.25)
Green (tax free)
Total
TAMP
NVENTORY
RIZONA ONLY
7. Beginning inventory - stamps on hand ........................
8. Stamps purchased during month .................................
9. Total stamps available..................................................
10. Deductions
a. Stamps spoiled .......................................................
b. Ending inventory - stamps on hand ........................
11. Total deductions: Add lines 10a and 10b ....................
12. Total stamps affi xed during month ...............................
NOTE: If line 6 does not equal the amount on line 12, attach an explanation of the difference to the back of this report.
Arizona Blue
Arizona Red
Arizona Green
S
C
I
($1.475)
($1.25)
(tax free)
Other States
TAMPED
IGARETTE
NVENTORY
13. Beginning inventory - packs on hand...........................
14. Adjustments:
a. Added into inventory ...............................................
b. Taken out of inventory .............................................
15. Total adjustments: Subtract line 14b from line 14a .....
16. Ending inventory ..........................................................
I have read this claim and any attachments with it. Under penalties of perjury, I declare that to the best of my knowledge and belief, they are true,
correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
►
TAXPAYER’S OR AUTHORIZED AGENT’S SIGNATURE
DATE
TITLE
►
PREPARER’S SIGNATURE
FIRM’S NAME (PREPARER’S IF SELF-EMPLOYED)
PREPARER’S TIN
DATE
PREPARER’S ADDRESS
Please mail to:
Arizona Department of Revenue, Tobacco Tax, 1600 W. Monroe, Phoenix, AZ 85007
ADOR 14-2042f (6/05)
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