Form 800nr - Cigarette Distributor'S Monthly Return For Nonresident Licensed Distributors - 2013

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Cigarette Distributor’s Monthly Return for

Arizona Form

Nonresident Licensed Distributors

Luxury Tax

800NR

This return is due the 20th day of the month following the reporting period.

Amended Return

Final Return

(CANCEL LICENSE)

Legal Business Name

Tobacco License No.:

Taxpayer I.D. No.:

Business (or dba) Name

Period Beginning:

Period Ending:

M D D Y Y Y Y

Mailing Address

City

State Zip

NEW

REVENUE USE ONLY. DO NOT MARK IN THIS AREA.

Business Location Address

City

State Zip

NEW

Name of Contact Person

Telephone No.

(with area code)

NEW

E-mail Address

Fax No.

NEW

(with area code)

NEW

81 PM

80 RCVD

Part 1 Cigarette Inventory: Read instructions before completing.

PACKS OF 20 PACKS OF 25

Blue Stamps

Section A: Taxable Regular

1 Stamped packages for sale in Arizona on hand (beginning of month) ..................................

2 Packages stamped during the month for sale in Arizona (Schedules A-3 and A-4) ...............

3 Ending Inventory: S S tamped packages for sale in Arizona (end of month) ............................

Line 1 + Line 2 − Line 3)

4 Taxable Distribution: Stamped packages delivered in Arizona .......(=

Red Stamps

Section B: Taxable Reservation

5 Stamped packages for sale in Arizona on hand (beginning of month) ..................................

6 Packages stamped during the month for sale in Arizona .......................................................

7 Ending Inventory: Stamped packages for sale in Arizona (end of month) ............................

Line 5 + Line 6 − Line 7)

8 Taxable Distribution: Stamped packages delivered in Arizona .......(=

Green Stamps

Section C: Tax Free Reservation

9 Stamped packages for sale in Arizona on hand (beginning of month) ..................................

10 Packages stamped during the month for sale in Arizona ....................................................... 10

11 Ending Inventory: Stamped packages for sale in Arizona (end of month) ............................

Line 9 + Line 10 − Line 11)

12 Taxable Distribution: Stamped packages delivered in Arizona ... (=

Unstamped

Section D: Tax Free Unstamped (Sold only to Arizona licensed distributors)

13 Untaxed Distribution: Unstamped packages delivered in Arizona (Schedules E-1 and E-2 .

Blue Stamps

Red Stamps

Green Stamps

Part 2: Stamp Inventory

14 Beginning inventory - Arizona stamps on hand........ 14

15 Arizona stamps purchased during the month .......... 15

16 Total stamps available. Add lines 14 and 15 ........... 16

17 Deductions:

a Stamps spoiled.................................................... 17a

b Ending inventory - Arizona stamps on hand........ 17b

18 Total deductions: Add lines 17a and 17b ................ 18

19 Total Arizona stamps afﬁ xed during the month:

Subtract line 18 from line 16; enter the difference ... 19

If line 19 does not equal amounts reported in Part 1, lines 2, 6, and 10, attach an explanation of the difference to the back of this report.

Part 3: Penalty

20 Penalty for late ﬁ ling or incomplete ﬁ ling (see instructions) ......................................................................

I have read this return 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, PO Box 29019, Phoenix, AZ 85038-9019

ADOR 11026 (9/13)