Arizona Form 835 - Domestic Farm Winery / Domestic Microbrewery / Domestic Cider Return Of Liquor Sold Page 3

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AZ FORM 835
Continuation Sheet
Continuation Sheet
Month _______________________
Month _______________________
MONTH YYYY
Schedule ____ No. ____ Of ____
Schedule ____ No. ____ Of ____
Check only one box:
Check only one box:
Vinous
Vinous
Malt
Malt
Cider
Cider
DATE
DATE
INVOICE
INVOICE
NAME OF SUPPLIER/
NAME OF SUPPLIER/
SHIPPED/
SHIPPED/
NO. OF
NO. OF
NO. OF
NO. OF
DATE
DATE
NUMBER
NUMBER
PURCHASER
PURCHASER
CITY
CITY
STATE
STATE
RECEIVED
RECEIVED
GALLONS
GALLONS
LITERS
LITERS
TOTAL THIS SHEET: Enter amounts on Schedule B, C or D ................................................
TOTAL THIS SHEET: Enter amounts on Schedule B, C or D ................................................
ADOR 14-2049f (2/07)
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