Arizona Form 800nr - Cigarette Distributor'S Monthly Report For Nonresident Licensed Distributors Page 2

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AZ Form 800NR Page 2 of 6

Schedule A

Cigarettes Sold in Arizona (except roll-your-own tobacco)

Please see instructions and deﬁ nitions beginning on page 5. Please provide the following information with respect to all Non-Participating Manufacturer (NPM) cigarettes (excluding

roll-your-own tobacco) that you stamped for sale in this state (i.e., on which you paid state excise tax).

NON-PARTICIPATING MANUFACTURERS BRANDS:

Invoice

Quantity

Name and Address of First Importer

(e)

(f)

Non-Participating Manufacturer’s

Name and Address of Person(s)

of Foreign Manufactured Brands

Name and Address (if known)

from Whom Purchased

(if known)

Brand Name

Individual

Packs of

(a)

(b)

(c)

(d)

Date

Number

Cigarettes

TOTAL .........................................................................................................................................................................................................................................................................................

ADOR 14-2013 (11/02)