Form Fr-800q - Sales And Use Tax Quarterly Return - 2012

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*128000710002*

2012

FR-800Q Sales and Use Tax

Government of the

District of Columbia

Quarterly Return

This is a FILL-IN format. Please do not handwrite any

data on this form other than your signature.

File this return for the 4 quarters of 2012 (Oct 2011 - Sept 2012).

OFFICIAL USE ONLY

Taxpayer Identification Number

Account number

Vendor ID#0002

Fill in:

if FEIN

Fill in:

if SSN

Due date

Fill in

if amended return

Business name

01202012

Fill in

if final return (See instructions)

Tax period ending (MMYY)

Mailing address line 1

1211

City

State

Zip Code + 4

Mailing address line 2

Sales tax licensees must file a return even if no sales were made or no tax or fees are due.

Column C — Tax due – multiply column B by tax rate, enter here

Column B — Taxable amount

Tax rate

Column A — Description

1. Use Tax on Purchases

X .06

Taxable at 6%

2. Gross Sales

3. Sales

X .06

Taxable at 6%

4. Sales and Purchases

X .10

of Off-Premises Alcohol

Taxable at 10%

5. Other Sales and

X .10

Purchases

Taxable at 10%

X .18

6. Sales for Parking

Taxable at 18%

X .12

7. Sales and Purchases

of Other Tobacco

Taxable at 12%

X .145

8. Sales and Purchases

Taxable at 14.5%

X .___

9. Reserved

10. Enter 2% of 911

10C

sales receipts less 3%

discount

11. Disposable Carryout

11C

Bag Fee

(Net of discount)

12. Reserved

12C

13. P enalty – 5% per month 13C

with a maximum of 25%

See instructions

14. I nterest – 10% per year 14C

See instructions

Total Amount Due

0.00

15.

15C

(Add Lines 1C - 14C)

Will the funds for this payment come from an account outside the US?

Yes

See page

Under penalties of law, I declare that this return is correct, to the best of my knowledge. Declaration of paid preparer is based on the information available to the preparer.

Telephone Number of Person to Contact

PLEASE

SIGN

HERE

Taxpayer’s signature

Title

Date

PAID

Paid Preparer’s

PTIN

PREPARER

Preparer’s signature (if other than taxpayer)