Arizona Form 800nr - Cigarette Distributor'S Monthly Return For Nonresident Licensed Distributors - Arizona Department Of Revenue

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Cigarette Distributor’s Monthly Return for
ARIZONA FORM
Luxury
Nonresident Licensed Distributors
Tax
800NR
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.
TOBACCO LICENSE NO.
TAXPAYER ID (EIN OR SSN)
FOR THE MONTH OF
20___
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.
Part 1 Cigarette Inventory: Read instructions beginning on page 6.
BLUE STAMPS
Packs of 20
Packs of 25
($1.18)
($1.475)
Section A: Taxable Regular
1. Stamped packages for sale in Arizona on hand (beginning of month) ..................................
2. Add: Packages stamped during the month for sale in Arizona (Schedules A-3 and A-4) .....
3. Ending Inventory: Stamped packages for sale in Arizona (end of month) ............................
4. Taxable Distribution: Stamped packages delivered in Arizona .............................................
RED STAMPS
Packs of 20
Packs of 25
($1.00)
($1.25)
Section B: Taxable Reservation
1. Stamped packages for sale in Arizona on hand (beginning of month) ..................................
2. Add: Packages stamped during the 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 .............................................
GREEN STAMPS
Packs of 20
Packs of 25
Section C: Tax Free Reservation
(tax free)
(tax free)
1. Stamped packages for sale in Arizona on hand (beginning of month) ..................................
2. Add: Packages stamped during the 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 .............................................
BLUE STAMPS
RED STAMPS
GREEN STAMPS
20
25
20
25
20
25
Part 2: Stamp Inventory
S
S
S
S
S
S
1. Beginning inventory - Arizona stamps on hand ...........
2. Arizona stamps purchased during the month ..............
3. Total stamps available..................................................
4. Deductions:
a. Stamps spoiled .......................................................
b. Ending inventory - Arizona stamps on hand ...........
5. Total deductions: Add lines 4a and 4b ........................
6. Total Arizona stamps affi xed during the month ............
If line 6 does not equal amounts reported in Part 1, lines A2, B2, and C2, attach an explanation of the difference to the back of this report.
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 14-2013 (8/05)

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