Arizona Form 819 - Schedule C, C-1, C-2
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3SCHEDULE C
AZ FORM 819
Schedule C
Sheet ___ of ___
Out-of-State Sales of Cigars and/or Tobacco Products During the Month
TOBACCO PRODUCT EXPORTED TO (name of state)
TOBACCO LICENSE NO.
TAXPAYER I.D. NO.
FOR THE MONTH OF
MONTH YYYY
LEGAL BUSINESS NAME
BUSINESS (or dba) NAME
Complete using the total rate of tax. Please see instructions before completing this form. If product sold in columns (g) or (h) constitutes “roll-your-own” per the definition found in
the Definitions section of the instructions, enter both here and on either Schedule C-1, if from a Participating Manufacturer, or Schedule C-2 if from a nonparticipating manufacturer.
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
No. of Small Cigars
No. of Ounces Sold
Sold Weighing
No. of Cigars Sold
No. of Cigars Sold
of Smoking Tobacco,
No. of Ounces
Name and Address
Date
Invoice
not more than
Selling for
Selling for
Snuff, Fine Cut
Sold of Cavendish,
of Purchaser
Sold
Date
Number
3 lbs/1000
$.05 or Less
More than $.05
Chewing, etc.
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
$.441 p er 20
$.218 per 3
$.218 p er 3
$.218 each
$.223 p er oz.
$.055 p er oz.
×
×
×
$.218 each
×
$.223 per oz.
×
$.055 per oz.
TOTAL RATES ...........................................................................................................................
4 Net taxes this month: See instructions ..................................................................................... 4
5 Total Tax 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. .......................................................................................
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Page 12
ADOR 11045 (9/13)
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