Form Fr-800se - Sales And Use Tax Special Event Return - 2012

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*128000510002*

Government of the

2012

FR-800SE Sales and Use Tax

District of Columbia

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

Special Event Return

data on this form other than your signature.

File this return for the months Oct 2011 - Sept 2012.

Taxpayer Identification Number

OFFICIAL USE ONLY

Fill in:

if FEIN

Vendor ID#0002

Fill in:

if SSN

Business name

Due date

Fill in

if amended return

11202011

Mailing address line 1

Tax period ending (MMYY)

1011

Mailing address line 2

City

State

Zip Code + 4

Event name

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%

X .10

5. Other Sales and

Purchases

Taxable at 10%

X .18

6. Sales for Parking

Taxable at 18%

7. Sales and Purchases

X .12

of Other Tobacco

Taxable at 12%

8. Sales and Purchases

X .145

Taxable at 14.5%

9. Reserved

X .____

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

ONLY

Preparer’s signature (if other than taxpayer)