Instructions Fo Form Tpt-1 - Transaction Privilege, Use And Severance Tax Page 3

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GROSS
LICENSE
TAXPAYER IDENTIFICATION
REPORT
COUNTY OR
BUSINESS CLASS
INCOME
NO.
NO.
PERIOD
CITY CODE
100
TRANSACTION PRIVILEGE, USE AND SEVERANCE TAX RETURN (TPT-1)
.
STATE LICENSE NO
TAXPAYER IDENTIFICATION NO.
ARIZONA DEPARTMENT OF REVENUE
E I N
PO BOX 29010, PHOENIX, AZ 85038-9010
S S N
PERIOD COVERED
BUSINESS
FROM
THROUGH
PAGE
OF
MAILING ADDRESS CORRECTION REQUESTED
NAME
F ILING FREQUENCY
THIS RETURN MUST BE FILED EVEN IF YOU HAD NO SALES
THESE AREAS FOR DEPAR TMENT U SE ONLY
TRAN
00
CODE
PAY
00
TYPE
ORIGINAL BD#
BD#
DEDUCTIONS
BUSINESS NAME: __________________________________________________________
C/O: _________________________________________________________________________
TAX RATE
ADDRESS: _________________________________________________________________
CITY/STATE/ZIP CODE: ____________________________________________________
RECEIPT
POSTMARK
ACCOUNTING
Check if mailing address has changed
CREDIT
COLUMN 3 X COLUMN 6 = COLUMN 7
COLUMN 3 X COLUMN 4 = COLUMN 5
COLUMN 1
COLUMN 2
COLUMN 3
COLUMN 4
COLUMN 5
COLUMN 6
COLUMN 7
L
Region
Bus.
R
I
= Accounting
Accounting
N
Code
Class
-
=
Gross
Deductions
Net Taxable
X Tax Rate
= Tax Amount
Business Description
C
Credit
Credit Rate
E
1
TAX
AMOUNT
2
3
4
5
6
7
8
9
10
11
12
*** ***
13
SUBTOTAL
*
14
STATE EXCESS
TTT
09
ENTER EXCESS STATE T AX COLLECTED..........................
PLUS
(+)
*
OTHER EXCESS
15
TTT 10
ENTER OTHER EXCESS TAX COLLEC TED.........................
PLUS
(+)
16
*
GRAND TOTAL
TTT 20
EQUALS (=)
17
ACCOUNTING CREDIT from line 16 column 7...................
MINUS (-)
25
PENALTY & INTER EST (see instructions)..........................
18
PLUS
(+)
30
TOTAL
19
ENTER TOTAL LIABILITY...................................................
EQUALS (=)
35
LIABILITY
20
ENTER CREDIT BALAN CE TO BE APPLIED....................
40
MINUS (-)
21
ENTER ESTIMATED PAYMENTS TO BE USED...............
45
MINUS (-)
22
99
ENTER NET AMOUNT DUE...............................................
EQUALS (=)
Please make check payable to: ARIZONA DEPARTMENT OF REVENUE
FOR THIS AMOUNT
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and state ments, and to the best of my knowledge and belief it is true, correct and complete. Declaration of
preparer (other tha n taxpayer) is base d on all information of which preparer has any knowledge.
Paid Preparer's S ignature (other than taxpayer)
Paid Preparer's EIN or SSN
Taxpayer's Signature
Date
SIGNATURE
ADOR 64-1046 (3/96)
NET AMOUNT
DUE
Page 3 Form N0. 64-1046 Rev. 3/96

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