Modified Business Tax Return General Business
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NEVADA DEPARTMENT OF TAXATION
TID No:020-TX
MODIFIED BUSINESS TAX RETURN
FOR DEPARTMENT USE ONLY
GENERAL BUSINESS
Mail Original To: NEVADA DEPARTMENT OF TAXATION
PO BOX 52609
PHOENIX AZ 85072-2609
PERIOD ENDING:
03/31/15
DUE BY:
04/30/15
DATE PAID:
IF POSTMARKED AFTER DUE DATE,
PENALTY AND INTEREST WILL APPLY
If the address as shown is incorrect, please make any
corrections before mailing the return. Use the space on
the left for these corrections.
1. TOTAL GROSS WAGES (INCLUDING TIPS) PAID THIS QUARTER
1.
(Same amount as on Line 3 of ESD Form NUCS 4072)
2. ENTER DEDUCTION FOR PAID HEALTH INSURANCE/HEALTH
2.
BENEFITS PLAN
3.
3. Line 1 minus Line 2
4.
4. Offset Carried Forward from Previous Quarter
5. Line 3 minus Line 4
5.
6. TAXABLE WAGES
(If line 5 is greater than zero enter amount here,
6.
if less than zero enter on Line 17)
7.
7. Is Amount on Line 6 greater than $85,000?
No. No tax is assessed on the first $85,000 of Taxable Wages. Enter $0 on line 7.
Yes. No tax is assessed on the first $85,000 of Taxable Wages. Enter $0 on line 7.
8. Did you answer Yes on Line 7?
No. Enter $0 on Line 8
Yes. Subtract $85,000 from Line 6 and enter amount on Line 8a. Multiply
amount on Line 8a by 1.17% (.0117) and enter amount on Line 8.
8.
8a.
x 0.0117
9. CALCULATED TAX
9.
(Line 7 + Line 8)
10. CREDITS
(Overpayments as determined by the Department)
10.
11. NET TAX DUE
(Line 9 minus Line 10)
11.
12. PENALTY (LINE 11 x 10%)
12.
13.
14. PREVIOUS DEBITS
(Outstanding liabilities)
14.
15. TOTAL AMOUNT DUE
(Line 11 + Line 12 + Line 13 + Line 14)
15.
16. AMOUNT PAID
16.
17. CARRY FORWARD
(If Line 5 is less than zero (0) enter
17.
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
TXR-020.04
MODIFIED BUSINESS TAX RETURN-GENERAL BUSINESS
Revised 03/27/15
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