AZ Form 815
Page 4
Continuation Sheet
Month of _________________ 19 ____
Schedule __________ No. ______ Of ______
Check One Box Only:
Spirits
Vinous
Malt
Cider
Date
Invoice
State/
shipped/
Name of Supplier / Purchaser
City
Gallons
Liters
County
Date
Number
received
Total this sheet. Enter amounts on Schedule A, B, C or D. ..........................................................................
ADOR 20-2048 (3/97)