Form Tpt-1 - Transaction Privilege, Use, And Severance Tax Return

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TRANSACTION PRIVILEGE, USE, AND

TPT-1 return is due the 20

day of the month following

the reporting period.

SEVERANCE TAX RETURN (TPT-1)

STATE LICENSE NUMBER:

Arizona Department of Revenue

PO BOX 29010 • PHOENIX, AZ 85038-9010

TAXPAYER IDENTIFICATION NUMBER:

For assistance out-of-state or in the Phoenix area: (602) 255-3381 or



EIN

SSN

Statewide, toll free from area codes 520 and 928: (800) 352-4090

PERIOD BEGINNING:

PERIOD ENDING:

I. TAXPAYER INFORMATION

M M D D Y Y Y Y

M D D Y Y Y Y

Amended

Multipage

One-Time

DOR USE ONLY



Final Return:

LABELED RETURN

Return

Only Return

(CANCEL LICENSE)

BUSINESS NAME

Print Form

C/O

ADDRESS

POSTMARK DATE

CITY

STATE

ZIP

RECEIVED DATE



Address Changed

II. TRANSACTION DETAIL (If more reporting lines are necessary, please attach continuation pages.)

(A)

(B)

(C)

(D)

(E)

(F)

(G)

(H)

(I)

(J) = (F × I)

BUSINESS

REGION

BUSINESS

ACCOUNTING

DESCRIPTION

CODE

GROSS AMOUNT

DEDUCTION AMOUNT

NET TAXABLE AMOUNT

TAX RATE

TOTAL TAX AMOUNT

CREDIT RATE

CREDIT

Subtotal .......................................

III. TAX COMPUTATION

1 Total deductions from Schedule A ...............................................................

2 Total Tax Amount (from column H) ..............................................................

3 State excess tax collected ...........................................................................

4 Other excess tax collected ..........................................................................

5 Total Tax Liability: Add lines 2, 3, and 4 ......................................................

6 Accounting Credit (from column J) ..............................................................

7 State excess tax accounting credit: Multiply line 3 by .01 ..........................

8 Total Accounting Credit: Add lines 6 and 7 .................................................

9 Net tax due line: Subtract line 8 from line 5 ................................................

10 Penalty and interest .....................................................................................

11 TPT estimated payments to be used ...........................................................

AMENDED RETURN ONLY

ORIGINAL REMITTED AMOUNT

12 Total amount due this period .......................................................................

13 Additional payment to be applied (for other periods) ...................................

DOR USE

14 TOTAL AMOUNT REMITTED WITH THIS RETURN ..................................

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.

►

PAID PREPARER’S SIGNATURE (OTHER THAN TAXPAYER)

►

TAXPAYER’S SIGNATURE

DATE

PAID PREPARER’S EIN OR SSN

Please make check payable to Arizona Department of Revenue.

ADOR 10872 (2/16)