Arizona Form 800nr - Cigarette Distributor'S Monthly Return For Nonresident Licensed Distributors - Arizona Department Of Revenue Page 4

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AZ FORM 800NR
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
, 20____
Please see instructions and defi nitions beginning on page 7.
(a)
(b)
(c)
BLUE STAMPS
RED STAMPS
GREEN STAMPS
Invoice
Invoice
(d)
(e)
(f)
(g)
(h)
(i)
Registration Number and Name
Date
Number
Packs of 20
Packs of 25
Packs of 20
Packs of 25
Packs of 20
Packs of 25
Total by Reservation .....................................................................................................................
Balance Forward from Other Reservations...................................................................................
GRAND TOTAL OF ALL RESERVATIONS ...................................................................................
ADOR 14-2013 (8/05)
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