Arizona Form 819nr - Nonresident Distributor'S Monthly Return Of Cigars And Tobacco Products Sold (For Nonresident Licensed Distributors) - Arizona Department Of Revenue Page 8

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AZ FORM 819NR

Schedule B-4

Sales of Cigars and/or Tobacco Products Sold During the Month on Arizona Indian Reservations –

that have enacted but do not collect their own tax and do not exempt their tribal members

LEGAL BUSINESS NAME

BUSINESS (OR DBA) NAME

TOBACCO LICENSE NO.

RESERVATION NAME

FOR THE MONTH OF

MONTH YYYY

Include copies of invoices. Please see instructions and deﬁ nitions beginning on page 16.

“-1” R

ETAILERS

No. of Small

No. of Ounces Sold

(Include allocated sales taxed only at the §42-3251 and §42-3251.01 rates to “-2” Retailers.)

Cigars Sold

No. of Cigars Sold

Smoking Tobacco,

No. of Ounces Sold

Invoice

weighing not more

for

Snuff, Fine Cut

Cavendish, Plug,

Registration Number

Name of Purchaser

Date

Number

than 3 lbs/1000

$.05 or less

more than $.05

Chewing, etc.

or Twist

1. Totals ...........................................................................................................................................

$.040 per 20

$.020 per 3

$.020 each

$.020 per oz.

$.005 per oz.

§42-3052 RATES ........................................................................................................................

$.040 per 20

$.020 per 3

$.020 each

$.020 per oz.

$.005 per oz.

2. Net taxes due distributor .............................................................................................................

3. Total tax due distributor. Also enter on page 1, line 4a.................................................................................................................................................................................................

$.223 per 20

$.110 per 3

$.110 each

$.113 per oz.

$.028 per oz.

§42-3251 and §42-3251.01 RATES ............................................................................................

$.223 per 20

$.110 per 3

$.110 each

$.113 per oz.

$.028 per oz.

4. Net taxes collected this month ....................................................................................................

5. Total tax collected this month from “-1” Retailers ..........................................................................................................................................................................................................

“-2” R

ETAILERS

(Include sales to unregistered retailers. Do not include sales listed under “-1” Retailers.)

Invoice

Small Cigars

Cigars

Ounces

Registration Number

Name of Purchaser

Date

Number

3 lbs/1000 or less

$.05 or less

more than $.05

Tobacco, etc.

Cavendish, etc.

6. Totals ...........................................................................................................................................

$.263 per 20

$.130 per 3

$.130 each

$.133 per oz.

$.033 per oz.

TOTAL RATES.............................................................................................................................

$.263 per 20

$.130 per 3

$.130 each

$.133 per oz.

$.033 per oz.

7. Net taxes collected this month ....................................................................................................

8. Total tax collected this month from “-2” retailers and unregistered retailers..................................................................................................................................................................

9. Total tax collected from retailers on these reservations (sum of lines 5 and 8). Do not enter on page 1..............................................................................................................

Page 8 of 17

ADOR 14-5322f (8/05)