Arizona Form 819 - Schedule D, E-1, E-2 Page 3

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SCHEDULE E-2

AZ FORM 819

Schedule E-2

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

Smoking Tobacco,

Sold

Name and Address of

Date

Invoice

not more than

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

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

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

$.441 p er 20

$.218 p er 3

$.223 p er oz.

$.055 p er 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 here and on page 1, line 8 ............................................................................

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ADOR 11045 (9/13)