Arizona Form 800nr - Cigarette Distributor'S Monthly Return For Nonresident Licensed Distributors - Arizona Department Of Revenue Page 2

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AZ FORM 800NR
Schedule A-3
Participating Manufacturer’s Cigarettes Sold in Arizona (except roll-your-own tobacco)
LEGAL BUSINESS NAME
BUSINESS (OR DBA) NAME
TOBACCO LICENSE NO.
FOR THE MONTH OF
, 20____
Please see instructions and defi nitions beginning on page 7. Please provide the following information with respect to all Participating Manufacturer’s cigarettes (excluding roll-your-own
tobacco) that you shipped to this state. A list of Participating Manufacturers, and their brands authorized for sale in Arizona, is maintained and updated at the Arizona Attorney General’s
web site,
PARTICIPATING MANUFACTURER’S BRANDS:
(a)
(b)
(c)
(d)
Quantity
Name and Address of
Who the Product Was Sold To
Participating Manufacturer’s Name
Brand Family
Packs of 20
Packs of 25
TOTAL .....................................................................................................................................................................................................................
Page 2 of 7
ADOR 14-2013 (8/05)

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