Form T-204r-Annual - Sales And Use Tax Return - Annual Reconciliation

State of Rhode Island and Providence Plantations

Form T-204R-Annual

16125299990101

Sales and Use Tax Return - Annual Reconciliation

Name

Federal employer identification number

Address

For the period ending:

12/31/2016

Address 2

NAICS code

City, town or post office

State

ZIP code

E-mail address

SALES AND USE TAX RETURN TO BE FILED BY SELLERS OF TANGIBLE PERSONAL PROPERTY

If you file a consolidated Sales Tax Return, list all locations by Rhode Island identification number including the 2 digit

location number. If there are more than 10 locations, please attach a separate listing. If you have multiple locations,

but file individual Sales Tax Returns, you must file a T-204R-Annual for each location.

Have you sold or closed your business?.......

If yes, on what date?

Yes

Before completing lines A through E, complete Schedules A and B on page 2.

Total Net Taxable Sales for the period Jan - Dec.

NOTE: Line A must equal Net Taxable Sales from pg 2, line 5

Amount of tax. Multiply line A by 7% (.07)..............................................................

MOTOR VEHICLE DEALERS ONLY

Sales tax collections from non-residents for the period Jan through Dec...............

Total Tax. Add lines B1 & B2.......................................................................................................................................

Total tax remitted for the period January through December...................................

Prepaid sales tax on cigarettes for the period January through December.............

ROOM RESELLERS ONLY

Sales tax paid to hotels ..........................................................................................

Credit balance (if any) per line D of the 2015 Annual Reconciliation return - Form T-204R

Sales tax due and paid to another state on items included in Schedule A, line 2.... C5

Total Tax Paid. Add lines C1 through C5.....................................................................................................................

Line C6 should equal line B3. If line B3 is more than line C6, there is a balance due. Please remit payment to

the RI Division of Taxation and send in with this Annual Reconciliation. See instructions for additional information.

If line C6 is more than line B3, there is a credit due which will be credited to the 2017 sales tax payments. Note:

Taxpayer must submit a “Claim for Refund” form with this reconciliation in order to receive a refund instead

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and

belief, it is true, accurate and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.

Authorized officer signature

Print name

Date

Telephone number

Paid preparer signature

Print name

Date

Telephone number

Paid preparer address

City, town or post office

State

ZIP Code