Arizona Form 800-25 - Cigarette Distributor'S Monthly Return - Arizona Department Of Revenue Page 6

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AZ FORM 800-25
Schedule B
Sales to Indian Retailers on the Reservation
LEGAL BUSINESS NAME
BUSINESS (OR DBA) NAME
TOBACCO LICENSE NO.
RESERVATION NAME
FOR THE MONTH OF
MONTH YYYY
Please see instructions and defi nitions beginning on page 12.
(a)
(b)
(c)
(d)
(e)
(f)
Invoice
Invoice
BLUE STAMPS
RED STAMPS
GREEN STAMPS
Registration Number and Name
Date
Number
Packs of 25
Packs of 25
Packs of 25
Total by Reservation .....................................................................................................................
Balance Forward from Other Reservations...................................................................................
GRAND TOTAL OF ALL RESERVATIONS ...................................................................................
Page 6 of 12
ADOR 14-2042f (6/05)

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