Form Et-1 Sample - Arkansas Excise Tax Return
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30-L1778900992 rtL001
Arkansas Excise Tax Return
ET-1 Form
SAMPLE
SAMPLE
ACCOUNT ID
12240001-SLS
:
SAMPLE
TEST ACCOUNT
PERIOD ENDING: March 31, 2009
55 FAR FAR AWAY
SAMPLE
DUE ON OR BEFORE: April 20, 2009
GALAXY AR 72121
Check box and attach a detailed explanation and
Amended Return
supporting documentation for amending the return.
Use whole dollars only.
Use blue or black ink only.
Gross Receipts Tax
A
B
C
D
E
F
(Sales by In-State Sellers)
Taxable Sales
Rate
Gross Tax Due
2% Discount
Tourism Credit
Net Tax Due
SAMPLE
SAMPLE
1. State Tax
6.000%
SAMPLE
2.
Food Tax
3.000%
SAMPLE
»»»»»»»»»»»»»»
3.
Mfg. Utility Tax
4.000%
SAMPLE
SAMPLE
4.
Aviation Tax
6.000%
»»»»»»»»»»»»»»
Vendor Use Tax
A
B
C
Rate
Net Tax Due
Taxable Sales
(Sales by Out-of-State Sellers)
SAMPLE
»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»
6.000%
5.
State Tax
SAMPLE
SAMPLE
»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»
3.000%
6.
Food Tax
4.000%
»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»
7.
Mfg. Utility Tax
6.000%
8.
Aviation Tax
»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»»
Consumer Use Tax
A
B
C
D
E
Taxable Purchases
Rate
Gross Tax Due
Economic Dev Credit
Net Tax Due
(Purchases by All Taxpayers)
6.000%
9.
State Tax
SAMPLE
3.000%
SAMPLE
10.
Food Tax
SAMPLE
SAMPLE
11.
Mfg. Utility Tax
4.000%
6.000%
12.
Aviation Tax
I DECLARE THIS RETURN (INCLUDING ANY ACCOMPANYING SCHEDULES)
31. Total State Tax
........................
(add Net Tax Due for lines 1 thru 12)
HAS BEEN EXAMINDED BY ME, AND TO THE BEST OF MY KNOWLEDGE
AND BELIEF IS TRUE, CORRECT AND COMPLETE.
32.
Total Special & Alcoholic Beverage Taxes
....
(from line 23)
SIGN
SAMPLE
HERE
33.
.................................................
Total Local Tax
(from line 30)
Owner, Partner or Corporate Officer
PRINT
SAMPLE
34.
Total Tax Due
......................................
(add lines 31, 32, and 33)
HERE
Contact Person
35.
Less Prepayments
.............................................
(if required)
36.
Net Tax Due
.......................
(enter this amount on the voucher below)
Date
Phone Number
Do Not Remove Voucher.
0-L1778900992 rtL001
Department of Finance & Administration
Taxpayer Name:
TEST ACCOUNT
Payment Voucher
SAMPLE
Make your check payable to “Department of Finance &
Administration”. Write your Account ID on the check. Please
SAMPLE
mail return and voucher with payment to the address
Account ID:
12240001-SLS
below:
Period Ending:
31-Mar-2009
DEPARTMENT OF FINANCE &
Amount Paid:
ADMINISTRATION
SAMPLE
P.O. BOX 3861
$
LITTLE ROCK, AR 72203-3861
SAMPLE
SLSACC12240001SLS03312009RTNPYM00000000000000000000000
SAMPLE
SAMPLE
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