Modified Business Tax Return
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NEVADA DEPARTMENT OF TAXATION
TID NO:020-TX
MODIFIED BUSINESS TAX RETURN
FOR DEPARTMENT USE ONLY
GENERAL BUSINESS
(Effective July 1, 2015)
Mail Original To: NEVADA DEPARTMENT OF TAXATION
PO BOX 7165
SAN FRANCISCO, CA 94120-7165
PERIOD ENDING:
Choose Date
DUE BY:
DATE PAID:
03/31/16
IF POSTMARKED AFTER DUE DATE, PENALTY AND
INTEREST WILL APPLY. If your business name or address has
changed, please contact the Call Center at (866) 962-3707 as soon as
possible to update your account with the Department.
1. TOTAL GROSS WAGES (INCLUDING TIPS) PAID THIS QUARTER
1.
2
. ENTER DEDUCTION FOR PAID HEALTH INSURANCE/HEALTH BENEFITS PLAN):
a
2
.
a
2
. ENTER DEDUCTION FOR QUALIFIED VETERANS WAGES
b
(See Instructions)
2
.
b
3. Line 1 minus Line 2a and Line 2b
3.
4.
4. Offset Carried Forward from Previous Quarter
5.
5. Line 3 minus Line 4
6. TAXABLE WAGES
6.
(If line 5 is greater than zero enter amount here, if less than zero enter on Line 17)
7.
7. ENTER THRESHOLD OF $50,000.
8. TAXABLE WAGES
(Line 5 minus Line 7, but not less than $0)
8.
9. CALCULATED TAX
(Line 8 x .01475)
9.
10. CREDITS
(Overpayments or other approved credits, see instructions)
10.
11. NET TAX DUE
(Line 9 minus Line 10)
11.
12.
12. PENALTY (LINE 11 x 0% see instructions)
13. INTEREST
(See instructions for current rate and calculation)
13.
14. PREVIOUS DEBITS
(Outstanding liabilities)
14.
15. TOTAL AMOUNT DUE
15.
(Line 11 + Line 12 + Line 13 + Line 14)
16.
16. AMOUNT PAID
17.
17. CARRY FORWARD
(If Line 5 is less than zero (0) enter
amount here. This Offset will be carried forward for the next quarter)
MAKE CHECK PAYABLE TO NEVADA DEPT OF TAXATION - A RETURN MUST BE FILED EVEN IF NO TAX LIABILITY EXISTS
I hereby certify that this return,
ENTER NAME OF PERSON
including any accompanying
SIGNING RETURN
schedules and statements, has been
examined by me and to the best of
Date
Phone
Signature
my knowledge and belief is a true,
correct and complete return. THIS
FEIN of Business Named Above
Title
RETURN MUST BE SIGNED
To e-mail, save this form to your computer
and e-mail the attachment to:
TXR-020.04
nevadaolt@tax.state.nv.us
MBT-GB
Revised 12/15/15
with the subject of
`Modified Business Tax Return'
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