Arizona Form 819nr - Nonresident Distributor'S Monthly Return Of Cigars And Tobacco Products Sold (For Nonresident Licensed Distributors) - Arizona Department Of Revenue Page 5
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17AZ FORM 819NR
Schedule B-1
Sales of Cigars and/or Tobacco Products Sold on Arizona Indian Reservations That Have Not Enacted Their Own Tax
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 and defi nitions beginning on page 15.
“-1” R
No. of Small
No. of Ounces Sold
ETAILERS
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 ...........................................................................................................................................
2. Quantity of line 1 sold tax free.....................................................................................................
×
$.263 per 20
×
$.130 per 3
×
$.130 each
×
$.133 per oz.
×
$.033 per oz.
$.263 per 20
$.130 per 3
$.130 each
$.133 per oz.
$.033 per oz.
TOTAL RATES.............................................................................................................................
$
$
$
$
$
3. Net amount due distributor for taxes paid but not collected ........................................................
4. Quantity of line 1 sold on which only the §42-3251 and §42-3251.01 rates were collected .......
×
$.040 per 20
×
$.020 per 3
×
$.020 each
×
$.020 per oz.
×
$.005 per oz.
$.040 per 20
$.020 per 3
$.020 each
$.020 per oz.
$.005 per oz.
§42-3052 RATE...........................................................................................................................
$
$
$
$
$
5. Net amount due distributor for taxes paid but not collected ........................................................
$
6. Total amount due distributor for taxes paid but not collected from “-1” Retailers (sum of lines 3 and 5).......................................................................................................................
“-2” R
ETAILERS
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.
7. Totals ...........................................................................................................................................
8. Quantity of line 7 sold tax free.....................................................................................................
×
$.263 per 20
×
$.130 per 3
×
$.130 each
×
$.133 per oz.
×
$.033 per oz.
$.263 per 20
$.130 per 3
$.130 each
$.133 per oz.
$.033 per oz.
TOTAL RATES.............................................................................................................................
$
$
$
$
$
9. Net amount due distributor for taxes paid but not collected ........................................................
$
10. Total amount due distributor for taxes paid but not collected from “-2” retailers (sum of line 9)....................................................................................................................................
11. Total amount due distributor for taxes paid but not collected (sum of lines 6 and 10). Enter here and on page 1, line 2 ...................................................................................
$
Page 5 of 17
ADOR 14-5322f (8/05)
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