Arizona Form 800nr - Schedule E-1, E-2

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SCHEDULE E-1

AZ FORM 800NR

Schedule E-1

Sheet ___ of ___

Sale of Unstamped Participating Manufacturer’s Cigarettes (except roll-your-own tobacco) to Another Arizona Licensed Distributor

CIGARETTES SOLD TO (name of distributor)

PURCHASER’S TOBACCO LICENSE NO.

FOR THE PERIOD OF

MDD Y Y Y Y

YOUR LEGAL BUSINESS NAME

YOUR BUSINESS (OR DBA) NAME

YOUR TOBACCO LICENSE NO.

Please see instructions before completing this form. Please provide the following information with respect to all Participating Manufacturer’s cigarettes (excluding roll-your-own

tobacco) that you exported from Arizona. A list of Participating Manufacturers, and their brands authorized for sale in Arizona, is maintained and updated at the Arizona Attorney

General’s web site,

(a)

(b)

(c)

(d)

(e)

(f)

Participating Manufacturer’s

Date

Invoice Number

Name and Address

Brand Family

Packs of 20

Packs of 25

1 Subtotal: This page only ............................................................................................................................................................................................................... 1

2 Balance Forward from Additional Sheets ....................................................................................................................................................................................... 2

3 GRAND TOTAL: Add lines 1 and 2 ............................................................................................................................................................................................... 3

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