Form 21-3 - Oklahoma Vendors Use Tax Report, Form 21-3-A - Oklahoma Vendor Use Tax Report Supplement Page 2
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3STU
STU0002-07-99-BT
Oklahoma Vendor Use Tax Report Supplement
Form 21-3-A Revised July 2010
D. Account Number
A. Taxpayer FEIN/SSN
B. Reporting Period
C. Due Date
M M D D
H. Page
of
Page(s)
F.
-Office Use Only-
F.C.
P.T.
Mailing
Business
G. “X” if Out
“X” for Address Change
E. Mailing Address
of Business
___________________________________________________
Name
___________________________________________________
Address
___________________________________________________
City
State
Zip Code
Distribution of Tax for Cities/Counties
City/
I.
J.
K.
L.
M.
N.
O.
Net
City/County
Interest
County
City/County Name
Taxable Sales
Use Tax
Discount
and Penalty
Total Due
Code
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
P.
Total City/County Tax (line 5 through line 24)
(Enter amount on Page 1, line 11)
If More Space is Needed, Use Supplemental Page(s)
The Oklahoma Tax Commission is not required to give actual notice of changes in any state tax law.
I declare under the penalties of perjury, this return (including any accompanying schedules) has been examined by me, and to the best of my knowledge and
belief is a true, correct, and complete return.
Signature of Taxpayer
Date
Prepared by
Date
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