Arizona Form 819 - Schedule B-4, B-5
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1
2SCHEDULE B-4
AZ FORM 819
Schedule B-4
Sheet ___ of ___
Sales of Cigars and/or Tobacco Products Sold During the Month on Arizona Indian Reservations –
that have enacted but do not collect their own tax and do not exempt their tribal members
LEGAL BUSINESS NAME
BUSINESS (OR DBA) NAME
TOBACCO LICENSE NO.
RESERVATION NAME
FOR THE MONTH OF
MONTH YYYY
Include copies of invoices. Please see instructions before completing this form.
(a)
(b)
(c)
(d)
(e)
“-1” R
--
No. of Small
No. of Ounces Sold
ETAILERS
(Include allocated sales taxed only at the §42-3251 and §42-3251.01 rates to “-2” Retailers.)
Cigars Sold
No. of Cigars Sold
No. of Cigars Sold
Smoking Tobacco,
No. of Ounces Sold
Invoice
Invoice
weighing not more
for
for
Snuff, Fine Cut
Cavendish, Plug,
Registration Number
Name of Purchaser
Date
Number
than 3 lbs/1000
$.05 or less
more than $.05
Chewing, etc.
or Twist
1 Totals ........................................................................................................................................
1
$.218 p er 20
$.108 p er 3
$.110 p er oz.
$.027 p er oz.
×
$.218 per 20 $.108 per 3 $.108 each $.110 per oz. $ .027 per oz.
×
×
$.108 each
×
×
§42-3052 and §42-3371 RATES ..............................................................................................
2 Net taxes due distributor: See instructions ..............................................................................
2
3 Total tax due distributor: Add the amounts in columns a, b, c, d, and e of line 2. Enter the total here and also enter on page 1, line 4a. ..............................................................
3
$.223 p er 20
$.110 p er 3
$.113 p er oz.
$.028 p er oz.
×
×
×
$.110 each
×
×
§42-3251 and §42-3251.01 RATES ............................................................................................
4 Net taxes collected this month: See instructions .....................................................................
4
5 Total tax collected this month from “-1” Retailers: Add the amounts in columns a, b, c, d, and e of line 4. Enter the total ......................................................................................
5
“-2” R
ETAILERS
(Include sales to unregistered retailers. Do not include sales listed under “-1” Retailers.)
Invoice
Invoice
Small Cigars
Cigars
Cigars
Ounces
Ounces
Registration Number
Name of Purchaser
Date
Number
3 lbs/1000 or less
$.05 or less
more than $.05
Tobacco, etc.
Cavendish, etc.
6 Totals ........................................................................................................................................
6
$.441 p er 20
$.218 p er 3
$.223 p er oz.
$.055 p er oz.
×
$.441 per 20 $.218 per 3 $.218 each $.223 per oz. $ .055 per oz.
×
×
$.218 each
×
×
TOTAL RATES .........................................................................................................................
7 Net taxes collected this month: See instructions .....................................................................
7
8 Total tax collected this month from “-2” retailers and unregistered retailers: Add the amounts in columns a, b, c, d, and e of line 7. Enter the total .............................................
8
9 Total tax collected from retailers on these reservations: Add lines 5 and 8. Enter the total here but do not enter on page 1. ........................................................................
9
Page 10
ADOR 11045 (9/13)
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