Tobacco License Questionaire / Distributor Reporting Requirements (Page 5 of 5) in pdf

Tobacco License Questionaire / Distributor Reporting Requirements Page 5

Cigarettes:

Initial if applicable, or write N/A if not applicable.

_____ Resident Distributors must:

File form 800-20 (cigarette tax) report, include copies of invoice(s) as required per instructions.

Do you plan to purchase and stamp for resale, cigarettes containing 25 sticks to a pack?

_____ Yes:

File Form 800-25 (cigarette tax) report, MUST also be filed with required copies of invoices.

_____ No:

You must inform the department immediately, if you begin purchasing and stamping packs of 25 for

resale.

_____ Non-Resident Distributors must:

File form 800 NR (cigarette tax) report, include copies of invoice(s) as required per instructions.

Note: If you are unsure whether you are a Resident Distributor or Non-Resident Distributor

please call (602) 716 – 7808.

_____ Pursuant to A.A.C. R15-3-312 a licensed tobacco distributor shall obtain cigarette stamps from

the Department and a distributor shall not sell, lend, give, or otherwise transfer tax stamps to

another distributor. Violation of A.A.C. R15-3-312 can result in the revocation of your tobacco

license. Upon revocation, any tobacco product found in your possession, or in any retail store

determined to have been supplied by you, will be subject seized and fines assessed.

I hereby acknowledge that I understand the reporting requirements associated with this license.

(Signature)

(Date)

SUBMIT all five (5) pages along with license application / renewal and annual license fee (and

Arizona Form 285, if applicable)

Any questions please call (602) 716 – 7808.

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Tobacco License Questionaire / Distributor Reporting Requirements Page 5