Arizona Form 819 - Schedule D, E-1, E-2

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SCHEDULE D

AZ FORM 819

Schedule D

Sheet ___ of ___

Credit for Unsellable Cigars and Tobacco Products Returned to Suppliers During the Month

LEGAL BUSINESS NAME

BUSINESS (or dba) NAME

TOBACCO LICENSE NO.

FOR THE MONTH OF

MONTH YYYY

Complete using the total rate of tax. Please see instructions before completing this form..

(g)

(a)

(b)

(c)

(d)

(e)

(f)

(h)

No. of Ounces

No. of Small Cigars

No. of Cigars

No. of Ounces

Returned Weighing

Returned Selling

Returned of Smoking

Returned of

Returned To (name of supplier)

Date

Invoice

not more than

for

Tobacco, Snuff, Fine

Cavendish,

Cut Chewing, etc.

City, State

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 returned this month: Add lines 1 and 2 ............................................................................ 3

$.441 p er 20

$.441 per 20 $.218 per 3 $.218 each

$.218 p er 3

$.223 p er oz.

$.223 per oz. $ .055 per oz.

$.055 p er oz.

$.218 each

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

4 Net amount to be deducted for returned product this month: See instructions ........................ 4

5 Total amount to be deducted for returned product this month: Add the amounts in columns d, e, f, g, and h of line 4. Enter here and on page 1, line 6 .................................

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ADOR 11045 (9/13)

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