Arizona Form 800nr (Schedule B) - Sales To Indian Retailers On The Reservation

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SCHEDULE B

AZ FORM 800NR

Schedule B

Sheet ___ of ___

Sales to Indian Retailers on the Reservation

LEGAL BUSINESS NAME

BUSINESS (OR DBA) NAME

TOBACCO LICENSE NO.

RESERVATION NAME

FOR THE PERIOD OF

MDD Y Y Y Y

Please see instructions before completing this form.

BLUE STAMPS

RED STAMPS

GREEN STAMPS

(a)

(b)

(c)

Invoice

(d)

(e)

(f)

(g)

(h)

(i)

Registration Number and Name

Date

Number

Packs of 20

Packs of 25

Packs of 20

Packs of 25

Packs of 20

Packs of 25

1 Total by Reservation ...............................................................................................................................

2 Balance Forward from Other Reservations ............................................................................................

3 GRAND TOTAL OF ALL RESERVATIONS: Add lines 1 and 2 in each column .....................................

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ADOR 11026 (9/13)