Form 14-117 - Texas Motor Vehicle Seller-Financed Sales Tax And/or Surcharge Report
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1
214-117
PRINT FORM
CLEAR FIELDS
(Rev.6-12/12)
Texas Motor Vehicle Seller-Financed
b.
Sales Tax and/or Surcharge Report
You have certain rights
under Chapters 552 and 559, Government Code,
to review, request and correct information we have on file about you.
78100
Do not write in shaded areas.
I
a.
Contact us at the address or phone number listed on this form.
d. Filing period
e.
c. Taxpayer number
f. Due date
IMPORTANT
h.
Blacken this box if your mailing address
g. Name and mailing address (Make any necessary name or address changes below.)
1.
has changed. Show changes
by the preprinted information.
Blacken this box if you are no longer
in business and write in the
2.
date you went out of business.
Month
Day
Year
ABCBCBD
i.
j.
1. Taxable receipts (Report dollars and cents)
NOTE: You must identify the county in which the motor vehicle title transfer occurred. For additional information on "Gross Receipts
Collected,""Receipts Subject to Tax" and for reporting title transfers for more than eight counties, refer to Specific Instructions
on the back of this form.
78100
78100
70100
(dollars and cents)
(dollars and cents)
(dollars and cents)
(dollars and cents)
County Name
Receipts subject to
Receipts Subject to
County
Gross Receipts
Receipts
Where Title is
2.5% Surcharge
1.0% Surcharge
Code
Collected
Subject to Tax
Transferred
1996 and earlier
1997 and later
1a.
1b.
1c.
1d.
1e.
1f.
1g.
1h.
1
c/c
2. Total receipts subject to tax and/or surcharge
2a.
2b.
2c.
(Total of Items 1a through 1h)
3a.
0.06250
3b.
0.02500
3c.
0.01000
3. Tax rate
4a.
4. Tax and/or surcharge due (Multiply Item 2 by Item 3)
4b.
4c.
5c.
5. Total amount of surcharge (Add Items 4b and Item 4c)
For additional
6a.
6c.
6. Prepayments (See instructions)
information
7. Net tax / surcharge due
7a.
7c.
(Subtract Item 6a from Item 4a; subtract Item 6c from Item 5c)
on vehicles
8. Discount (If filed and paid on time,
subject to
8a.
8c.
multiply Item 4a by .005, multiply Item 5c by .005)
the surcharge,
9a.
9c.
9. Total tax and/or surcharge due (Subtract Item 8 from Item 7)
see specific
instructions
14-117 (Rev.6-12/12)
on the back
of this form.
10a.
10c.
10. Penalty and interest (See instructions)
11. Amount due (Add Item 9a and Item 10a;
11a.
11c.
add Item 9c and Item 10c)
k.
l.
Total Amount Due and Payable
12.
(Add Item 11a and Item 11c)
12.
Taxpayer name
m.
T Code
Taxpayer number
Period
I declare that the information in this document and any attachments is true and correct to
the best of my knowledge and belief.
78920
Duly authorized agent (PLEASE PRINT NAME)
Make the amount in Item 12
Mail to: Comptroller of Public Accounts
P.O. Box 149360
payable to
State Comptroller
Austin, TX 78714-9360
For information about Motor Vehicle Sales and Use Tax or Surcharge,
Business phone
Date
1-800-252-1382
512-463-4600
call
or
.
333 C
Details are also available online at
.
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