Form Tpt-1 - Tax Return Form - City Of Mesa
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1
2Revenue Collection Operations
License No. ________________
License No. ________________
Special Licensing Office
Location:
Location:
Mailing:
Mailing:
55 North Center Street
Reporting Period ____________
Reporting Period ____________
55 North Center Street
55 North Center Street
PO Box 16350
PO Box 16350
Mesa Arizona 85201
Mesa, Arizona 85201
Mesa, Arizona 85201
Mesa, AZ 85211‐6350
Mesa, AZ 85211‐6350
(480)644-2316
Fax(480)644-3999
Phone: (480) 644‐2316
Phone: (480) 644‐2316
Fax: (480) 644‐3999
Fax: (480) 644‐3999
Due Date __________________
Due Date __________________
Hours: 7:00 AM ‐ 6:00 PM
Hours: 7:00 AM ‐ 6:00 PM
Days: Monday ‐ Thursday
Days: Monday ‐ Thursday
CANCEL LICENSE:
CANCEL LICENSE:
Closed on Fridays
Closed on Fridays
Check here and sign at the
Check here and sign at the
Please indicate mailing address change here.
Please indicate mailing address change here.
bottom to cancel your license.
bottom to cancel your license.
Business Name
Business Name
Reason ________________________________
Reason ________________________________
Address
Address
Date Business Closed _____________________
Date Business Closed _____________________
City/State/Zip
City/State/Zip
TRANSACTION PRIVILEGE TAX (TPT) AND USE TAX RETURN
Place a check here and sign at the
THIS RETURN IS DUE ON
THIS RETURN IS DUE ON
THE 20TH OF THE MONTH
THE 20TH OF THE MONTH
bottom if you have no taxes to file
Column 1
Column 2
Column 3
Column 4
Column 5
x Tax
Allowable pg 2
Business Description
Bus. Class
Gross
= Net Taxable
= Tax Amount
Rate
Line
- Deductions
1.75%
1
1.75%
2
1.75%
3
1.75%
1.75%
4
4
1.75%
5
1.75%
6
USE TAX
20
1.75%
7
1.75%
TOTAL FROM ADDTL PAGES
8
SUBTOTAL
1.75%
9
10
(Total from Schedule B) EXCESS CITY TAX COLLECTED/JET FUEL
Plus
(+)
TOTAL TAX DUE
11
Equals (=)
(see instructions) PENALTY & INTEREST
12
Plus
(+)
ENTER TOTAL LIABILITY
13
Equals (=)
(Total from Schedule B) CREDIT TO BE APPLIED
14
Minus (-)
ENTER NET AMOUNT DUE
15
Equals (=)
ENTER TOTAL AMOUNT PAID
16
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer
has any knowledge.
T axpa ye r's S ig na tu re
D ate
P a id P rep a rer's S ign atu re
P rin t N a m e
P ho ne #
P rin t P aid P re pa re r's N am e
A SIGNATURE IS REQUIRED TO MAKE THIS RETURN VALID
Mailing Address
Return original with remittance in envelope provided.
PO Box 16350
Please make check payable to: CITY OF MESA
Mesa Arizona 85211-6350
Complete both sides of form.
(TPT-1) (Rev. 06-2009)
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