Form Eff A Return - Exhibition Facility Fee Return - Business License Annual Filing

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NEVADA DEPARTMENT OF TAXATION
EXHIBITION FACILITY FEE RETURN - BUSINESS LICENSE
ANNUAL FILING
TID NO:
FOR DEPARTMENT USE ONLY
MAIL ORIGINAL TO:
NEVADA DEPARTMENT OF TAXATION
1550 COLLEGE PARKWAY SUITE 115
DATE:
CARSON CITY NEVADA 89706
CHECK AMOUNT:
CHECK NO:
POSTMARK:
INITIALS
Return for Year Ending: June 30,
Due on or Before: July 1,
If the name or address shown is incorrect, the ownership or business
location has changed, or if you are out of business, notify the
IF POSTMARKED AFTER DUE DATE PENALTY
Tax Examiner at 775-684-2130
WILL APPLY
A RETURN MUST BE FILED EVEN IF NO TAX LIABILITY EXISTS
1.
ANNUAL FEE
$5,000.00
2.
PENALTY
$
(SEE INSTRUCTIONS FOR RATE)
3.
5,000.00
TOTAL AMOUNT DUE AND PAYABLE
$
4.
TOTAL AMOUNT REMITTED WITH RETURN
$
MAKE CHECK PAYABLE TO:
NEVADA DEPARTMENT OF
TAXATION
I HEREBY CERTIFY THAT THIS RETURN INCLUDING ANY ACCOMPANYING SCHEDULES AND STATEMENTS HAS BEEN
EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE
RETURN.
RETURN MUST BE SIGNED
___________________________________________
______________
__________________________
SIGNATURE OF TAXPAYER OR AUTHORIZED AGENT
DATE
PHONE NUMBER (WITH AREA CODE)
___________________________________________
___________________________________________
TITLE
FEDERAL TAX ID NUMBER (EIN OR SSN)
PLEASE SUBMIT IN THE ENVELOPE PROVIDED
EXC- EFF- 01.01
EFF A RETURN
REVISED 5-25-07

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