Form 401 - Business Activity Tax Return Navajo Nation
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1401
FORM
B
A
T
R
USINESS
CTIVITY
AX
ETURN
TIN/SSN
: #
Please Check Appropriate Box :
Separate Return
Combined Return
Check box if AMENDED and enter correct Reporting Period
(below) being "amended"
Taxpayer Name
Reporting Period (Quarter)
ONTC
[Due 45 days after end of Quarter]
OFFICE USE
ONLY
Mailing Address
Business Activity
Check here if mailing address has changed.
RELATED BRANCH INFORMATION: Form 404 must be filed if one of a group of related branches.
Gross Receipts
(Enter Whole Dollars)
1. Navajo goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Navajo services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . +
3. Total gross receipts (Add Line 1 and Line 2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
Deductions
4. Standard deduction - $125,000
or 10% of Line 3 . . . . . . . . . . . . . . . . -
5. Salaries, wages, & other compensation paid to Navajos, Form 402 . . . . -
6. Purchase of Navajo goods, Form 403 - Part A . . . . . . . . . . . . . . . . . . . . . -
7. Purchase of Navajo services, Form 403 - Part B . . . . . . . . . . . . . . . . . . . -
8. Payments made to the Navajo Nation government,
. -
Form 403 - Part C
9. Total Deductions (Add Lines 4 through 8) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
10. Navajo source gains (Line 3 less Line 9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
11. Business Activity Tax (Line 10 times 5%) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
12. Tax paid with extension request (Form 145 must have been timely filed) . . . . . . . . . . . . . . -
13. Balance of Tax Due (Line 11 less Line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
14. Interest(s) - if applicable. Calculate interest owed & enter amount
. . . . . +
(attach calculations)
15. Penalty(s) - if applicable. Calculate penalties owed and enter amount
. . . +
(attach calculations)
16. TOTAL TAXES DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . =
For payments
under $10,000 make
Payments
over $10,000 must be wire transferred
check payable to the order of & mail to:
to the following account:
Office of the Navajo Tax Commission
The Navajo Nation
Check here if
Post Box 1903
Account Number: 4000901560
payment is made
Window Rock, Arizona 86515-1903
Wells Fargo Bank - Window Rock Branch
by wire transfer
Phone: (928) 871-6681
Window Rock, Arizona 86515
Amount
Fax: (928) 871-7608
Bank Routing Number: 091000019
$
I declare that the information contained in this document and any attachments thereto is true and correct to
the best of my knowledge and belief pursuant to all Navajo Nation laws and regulations.
x
(
)
/
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Taxpayer or Duly Authorized Agent Signature
Print or Type Name
Telephone Number
Date
ONTC
BAT - Form 401
Revised: 2/12/02
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Parent category: Financial