Form 10 - Nebraska And Local Sales And Use Tax Return
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1
2
3
4Nebraska and Local Sales and Use Tax Return
FORM
• If applicable, complete Schedule I on reverse side.
10
• See optional Nebraska Net Taxable Sales and Use Tax Worksheets.
PLEASE DO NOT WRITE IN THIS SPACE
Tax Period
Tax Category
Nebraska ID Number
Rpt. Code
Due Date:
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
• Name, address, or ownership changes? See instructions.
Check this box if your business has permanently closed, has been sold to someone else, or your permit is no longer needed.
New owners must apply for their own sales tax permit.
1 Gross sales and services (see instructions) .......................................................................................
1
00
2 Net taxable sales (see instructions) ....................................................................................................
2
00
3 Nebraska sales tax (line 2 multiplied by .055) ....................................................................................
3
4 Nebraska use tax (see instructions) ............................................................. 4
Complete Nebraska Schedule I prior to completing lines 5 & 6.
5 Local use tax from line 1, Nebraska Schedule I ........................................... 5
6 Local sales tax from line 2, Nebraska Schedule I ..............................................................................
6
7 Total Nebraska and local sales tax (line 3 plus line 6) ........................................................................
7
8 Sales tax collection fee (line 7 multiplied by .025; if the result is $75.00 or more, enter $75.00) .......
8
9 Sales tax due (line 7 minus line 8) .....................................................................................................
9
10 Total Nebraska and local use tax (line 4 plus line 5) .......................................................................... 10
11 Total Nebraska and local sales and use tax due (line 9 plus line 10) ................................................. 11
12 Previous balance with applicable interest at
% per year and payments received through
12
Check this box if your payment is being made electronically.
13 BALANCE DUE (line 11 plus or minus line 12). Pay in full with return ............................................... 13
Under penalties of law, I declare that as taxpayer or preparer I have examined this return, including accompanying schedules and
statements, and to the best of my knowledge and belief, it is correct and complete.
sign
(
)
here
Authorized Signature
Title
Daytime Phone
Date
Email Address
paid
preparer’s
Preparer’s Signature
Date
Preparer’s PTIN
use only
(
)
Print Firm’s Name (or yours if self-employed), Address and Zip Code
EIN
Daytime Phone
For tax assistance, call 800-742-7474 (Nebraska and Iowa) or 402-471-5729.
THIS RETURN IS DUE ON OR BEFORE THE 20
TH
DAY OF THE MONTH FOLLOWING THE TAX PERIOD INDICATED ABOVE.
Paper filers mail this return and payment to: NEBRASKA DEPARTMENT OF REVENUE, PO BOX 98923, LINCOLN, NE 68509-8923.
10-2011
Supersedes 6-002-1967 Rev. 6-2011
6-002-1967 Rev.
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