Form Rp-11 - Indiana Annual Consolidated Sales Tax Information Return

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Form RP-11
Indiana Annual Consolidated Sales Tax
State Form 49066
Information Return
(R5/01-06)
Please return to:
Indiana Department of Revenue
If the preprinted information listed below is not correct,
Consolidated Sales Tax
please do not make corrections on the label. Use the
100 N. Senate Avenue
Change of Address Form found with your sales tax vouchers
Indianapolis, IN 46204-2253
to report any address change.
Phone (317) 232-2104
B.
Total Gross Sales
(Line 1 on Form ST-103)
$ _______________________
Total Exempt Sales
(Line 2 on Form ST-103)
$ _______________________
A.
In what county is your home office located? If out of state, enter (00).
Total Taxable Sales
(Line 3 on Form ST-103)
$ _______________________
_______________________________________________
Total Tax Collected
(Line 4 on Form ST-103)
$ _______________________
C.
Sales Tax Collection Breakdown by County in Which Business Sites are Located
County Name and
Tax
County Name and
Tax
County Name and
Tax
Code Number
Collected
Code Number
Collected
Code Number
Collected
11 Adams
32 Hendricks
63 Pike
12 Allen
33 Henry
64 Porter
13 Bartholomew
34 Howard
65 Posey
14 Benton
35 Huntington
66 Pulaski
15 Blackford
36 Jackson
67 Putnam
16 Boone
37 Jasper
68 Randolph
17 Brown
38 Jay
69 Ripley
18 Carroll
39 Jefferson
70 Rush
19 Cass
40 Jennings
71 St. Joseph
10 Clark
41 Johnson
72 Scott
11 Clay
42 Knox
73 Shelby
12 Clinton
43 Kosciusko
74 Spencer
13 Crawford
44 LaGrange
75 Starke
14 Daviess
45 Lake
76 Steuben
15 Dearborn
46 LaPorte
77 Sullivan
16 Decatur
47 Lawrence
78 Switzerland
17 DeKalb
48 Madison
79 Tippecanoe
18 Delaware
49 Marion
80 Tipton
19 Dubois
50 Marshall
81 Union
20 Elkhart
51 Martin
82 Vanderburgh
21 Fayette
52 Miami
83 Vermillion
22 Floyd
53 Monroe
84 Vigo
23 Fountain
54 Montgomery
85 Wabash
24 Franklin
55 Morgan
86 Warren
25 Fulton
56 Newton
87 Warrick
26 Gibson
57 Noble
88 Washington
27 Grant
58 Ohio
89 Wayne
28 Greene
59 Orange
90 Wells
29 Hamilton
60 Owen
91 White
30 Hancock
61 Parke
92 Whitley
31 Harrison
62 Perry
00 Out-of-State
This return must be signed by the owner, partner or corporate officer.
Signature
Title
Date
_____________________________________________
___________________________
_________________
(
)
Telephone Number
_______________________________________________________
__________________________
Please print or type the signature name.

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