Arizona Form 800nr - Cigarette Distributor'S Monthly Report For Nonresident Licensed Distributors
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Cigarette Distributor’s Monthly Report for
ARIZONA FORM
800NR
Tax
Nonresident Licensed Distributors
For the month _______________________, 20____
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.
Licensed Distributor’s Name
Tobacco License No.
Taxpayer ID (EIN or SSN)
Mailing Address
Address of Business Location
City
State
Zip
City
State
Zip
Read instructions beginning on page 5.
Part 1 Cigarette Inventory
BLUE STAMPS
Pkgs of 20
Pkgs of 25
Section A: Taxable Regular
($1.18)
($1.475)
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 .............................................
RED STAMPS
Pkgs of 20
Pkgs of 25
Section B: Taxable Reservation
($1.00)
($1.25)
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
Pkgs of 20
Pkgs 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
Part 2: Stamp Inventory
20
25
20
25
20
25
S
S
S
S
S
S
1. Arizona stamps on hand (beginning of month) ............
2. Add: Arizona stamps purchased during the month .....
3. Less: Arizona stamps on hand (end of month) ...........
4. Arizona stamps affi xed during the month.....................
If line 4 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 (11/02)
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