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AZ FORM 800NR

Instructions

(except where such importer is an original participating

Column (a): Enter the name and address of the nonparticipating

manufacturer (as that term is deﬁ ned in the Master Settlement

manufacturer of the brand family of NPM cigarettes reported in

Agreement) that will be responsible for the payments under

Column (c).

the Master Settlement Agreement with respect to such

Column (b):

Enter the name and address of who the NPM

cigarettes as a result of the provisions of subsection II(MM)

cigarettes reported in Column (c) were sold to.

of the Master Settlement Agreement and that pays the

Column (c):

Enter the brand family of the NPM cigarettes

taxes speciﬁ ed in subsection II(Z) of the Master Settlement

(do not abbreviate). Do not break the brand family down into

Agreement, and provided that the manufacturer of such

subcategories such as regular, menthol, light, etc. For example,

cigarettes does not market or advertise such cigarettes in the

for a cigarette named “Alpha Bravo Gold Menthol Lights”, report

United States);

only “Alpha Bravo Gold”. Do not report as “A B Gold” or “A B Gold

2) Is the ﬁ rst purchaser anywhere for resale in the United States

Menthol Lights.”

of cigarettes manufactured anywhere that the manufacturer

Column (d): Enter the date and invoice number of the invoice

does not intend to be sold in the United States; or

pursuant to which you sold the cigarettes identiﬁ ed in Column (c).

3) Becomes

successor

entity

described

Column (e): Enter the number of individual NPM cigarettes or

paragraph 1 or 2.

packages of 20 or 25 cigarettes, excluding roll-your-own, for which

The term “tobacco product manufacturer” does not include an

the distributor afﬁ xed the excise tax stamp of this state or otherwise

afﬁ liate of a tobacco product manufacturer unless such afﬁ liate

paid state excise taxes.

itself falls within any of paragraphs 1 through 3 above.

If you have not engaged in any activity during the applicable

“Participating manufacturer” has the same meaning prescribed

period, you must complete and submit the Nonresident Distributor’s

in Section II(jj) of the Master Settlement Agreement and all

Certiﬁ cation of No Nonparticipating Manufacturer Activity (In Lieu of

amendments thereto. A list of participating manufacturers and their

Nonparticipating Manufacturer’s Schedules) on page 5.

brands is maintained and updated at the web site of the National

Association of Attorneys General,

SPECIAL INSTRUCTIONS FOR SCHEDULE B

“Nonparticipating manufacturer” (NPM) means any tobacco product

Complete a separate Schedule B for each reservation.

manufacturer that is not a Participating Manufacturer.

List all sales to authorized Indian retailers. For a current list of

retailers authorized to receive red or green stamped cigarettes,

“State excise taxes” means taxes imposed on tobacco products

call the Arizona Department of Revenue Tobacco Tax Section at

under A.R.S. Title 42, Chapter 3.

(602) 716-7808. Each transaction must include the following:

SPECIAL INSTRUCTIONS FOR SCHEDULE A-3

Column (a):

Enter the registration number and name of the

PARTICIPATING MANUFACTURER’S CIGARETTES

retailer.

SOLD IN ARIZONA (EXCEPT ROLL-YOUR-OWN TOBACCO)

Column (b): Enter invoice date.

This report must be completed for every cigarette brand family

Column (c): Enter invoice number.

(excluding roll-your-own tobacco) manufactured by a participating

Column (d):

Enter number of blue stamped 20s sold.

(For

manufacturer for which the distributor afﬁ xed the excise tax stamp

information only to be included in Section A, line 4.)

of this state or otherwise paid state excise taxes.

Column (e):

Enter number of blue stamped 25s sold (For

Column (a): Enter the name of the participating manufacturer of

information only to be included in Section A, line 4.)

the brand family of cigarettes reported in Column (c).

Column (f): Enter number of red stamped 20s sold.

Column (b): Enter the name and address of who the brand family

of cigarettes, reported in Column (c), were sold to.

Column (g): Enter number of red stamped 25s sold.

Column (c):

Enter the brand family of the cigarettes sold

Column (h): Enter number of green stamped 20s sold.

(do not abbreviate). Do not break the brand family down into

Column (i): Enter number of green stamped 25s sold.

subcategories such as regular, menthol, light, etc. For example,

for a cigarette named “Alpha Bravo Gold Menthol Lights”, report

Total by Reservation: Enter total of each column.

only “Alpha Bravo Gold”. Do not report as “A B Gold” or “A B Gold

Balance forwarded from other reservations: Enter the totals of

Menthol Lights.”

each attached Schedule B.

Column (d): Enter the number of packages of 20 or 25 cigarettes,

Grand total of all reservations.

excluding roll-your-own, for which the distributor afﬁ xed the excise

tax stamp of this state or otherwise paid state excise taxes during

CERTIFICATION OF NO NPM ACTIVITY:

the month.

If you have not engaged in any activity required to be reported on

Form 819NR, Schedule A-4, or Form 800NR, Schedule A-4 during

SPECIAL INSTRUCTIONS FOR SCHEDULE A-4

the applicable period, you must complete and submit the form,

NONPARTICIPATING MANUFACTURER’S (NPM) CIGARETTES

Nonresident Distributor’s Certiﬁ cation of No Nonparticipating

SOLD IN ARIZONA (EXCEPT ROLL-YOUR-OWN TOBACCO)

Manufacturer

Activity

(In

Lieu

Nonparticipating

This report must be completed for every cigarette brand family

Manufacturers Schedules).

(excluding roll-your-own tobacco) manufactured by a NPM for

which the distributor afﬁ xed the excise tax stamp of this state or

otherwise paid state excise taxes.

Attach copies of invoices listed in column (d) to Schedule A-4 for

nonparticipating manufacturer products shipped to Arizona.

Page 7 of 7

ADOR 14-2013 (8/05)

Arizona Form 800nr - Cigarette Distributor'S Monthly Return For Nonresident Licensed Distributors - Arizona Department Of Revenue Page 7

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