Arizona Form 819nr - Schedule C-3, D

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SCHEDULE C-3
AZ FORM 819NR
Schedule C-3
Sheet ___ of ___
Sales of Cigars and/or Tobacco Products to Other Arizona Licensed Distributors Who Have Agreed to Pay the Tax
LEGAL BUSINESS NAME
BUSINESS (OR DBA) NAME
TOBACCO LICENSE NO.
FOR THE MONTH OF
MONTH YYYY
Please see instructions before completing this form.
(g)
(a)
(b)
(c)
(d)
(e)
(f)
(h)
No. of Ounces Sold
No. of Small Cigars
No. of Ounces
Sold Weighing
No. of Cigars Sold
No. of Cigars Sold
Smoking Tobacco,
Sold
Name and Address of
Date
Invoice
not more than
for
for
Snuff, Fine Cut
Cavendish,
Chewing, etc.
Who the Product was Sold To
Shipped
Date
Number
3 lbs/1000
$.05 or Less
More than $.05
Plug or Twist
1 Total this sheet .......................................................................................................................... 1
2 Total all other sheets ................................................................................................................ 2
3 Total sold this month: Add lines 1 and 2 ................................................................................... 3
$.223 per oz.
$.441 p er 20
$.218 per 3
$.218 p er 3
$.223 p er oz.
$.055 p er oz.
$.441 per 20
$.218 each
$.055 per oz.
×
×
×
$.218 each
×
×
TOTAL RATES ...........................................................................................................................
4 Net non-taxable sales this month: See instructions ................................................................. 4
5 Total Non-Taxable Sales This Month: Add the amounts in columns d, e, f, g, and h of line 4. Enter the total here and on page 1, line 5 ..............................................................
5
Page 10
ADOR 10531 (9/13)

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