Form St - Sales, Use, And Gross Receipts Tax - North Dakota Tax Commissioner
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North Dakota Office of State Tax Commissioner
ST - Sales, Use, and Gross Receipts Tax
Fill in this circle if you are no longer in business
(A)
Fill in this circle if this is an amended return.
and enter your last day of business.
(F)
Account
Due Date
/
/
Number
of Return
*Required (Ex: 999999 00)
M M
D D
Y
Y
Y
Y
Period
Fill in this circle if this business has changed
Ending
ownership. Provide name, address, and telephone
*Required (Ex: MM/DD/YYYY)
(C)
number of new owner:
Taxpayer Name
New Owner Name, Address, Phone Number
Address
City, State, ZIP Code
Fill in this circle if your address has changed.
Column A
Column B
5% Sales & Purchases
.0 0
.0 0
1. Total Sales
(do not include tax)
.0 0
.0 0
2. Total Nontaxable Sales
3. Items Subject to Use Tax
.0 0
.0 0
.0 0
4. Taxable Balance
.0 0
(Add lines 1 and 3, and subtract line 2)
5. State Tax
(Multiply line 4 by the ND tax rate)
6. Total State Tax
(Add column A and column B on line 5)
7. Compensation Discount - Registered Permit Holders only
(Multiply line 6 by .015 ($93.75 maximum) - see instructions)
8. Net State Tax Due
(subtract line 7 from line 6)
9. Penalty
(a)
(b)
(See Instructions)
10. Interest
(See Instructions)
11. State Tax, Penalty, and Interest
LOCAL OPTION SALES, USE, & GROSS RECEIPTS TAXES
E
To report more than ten local option taxes, see Instructions.
Compensation
F
C
D
Net Local Option Tax Due
A
Allowance
Total Local Option Tax
B
Compensation
Local Code
(Do Not Enter Sales)
Rate
(See Instructions)
(Column C Minus Column E)
City or County Name/Location
.
.
.
.
.
.
.
.
.
.
12. Net Local Option Tax Due
13. Total Local Option Penalty and Interest
(See Instructions)
14. Total Due With Return
Make check or money order payable to North Dakota Tax Commissioner
I declare that this return has been examined by me and to the best of my knowledge and belief
Please Do Not Write In This Space
is a true, correct, and complete return.
Taxpayer Signature
Date
Title
Contact Person (Please Print or Type)
Contact Phone Number
Taxpayer Copy
Mail to: Office of State Tax Commissioner,
PO Box 5623, Bismarck, ND 58506-5623
1/2012
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