01-116-A Form Texas List Supplement - Sales And Use Tax

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CLEAR FIELDS
01-116-A
FFFF
*01116A0W021515*
(Rev.2-15/15)
Instructions in English
Texas List Supplement
- SALES AND USE TAX ­
FILING REQUIREMENTS
e.
d. Filing period
26120
c. Taxpayer
a.
number
b
b
b
f. Taxpayer name
g. Due date
012 3 45 67 89
PRINT YOUR NUMERALS LIKE THIS
I
Do not staple or paper clip.
Do not write in shaded areas.
I
I
2. CITY/TRANSIT/
3. AMOUNT SUBJECT TO TAX
5. AMT. OF TAX DUE
1. CITY/TRANSIT/COUNTY
(Whole dollars only)
(Multiply Item 3 by Item 4)
4. TAX RATE
/SPD NAME
COUNTY/SPD NO.
b
b
b
**
Jurisdictions with two asterisks
**
(
) next to them indicates
LOCAL TAX
you have at least one outlet
within that jurisdiction. You
7b. TOTAL DUE ON THIS PAGE
must include the amount
You have certain rights
subject to tax for that outlet(s),
under Chapters 552 and 559, Government Code, to review, request and correct
even if the amount is zero.
information we have on file about you. Contact us at the address or phone number listed in the instructions.

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