4100200
222
STS
222
P.
If report is typed
or machine printed
STS0002-02-00-BT
Oklahoma Sales Tax Report
see instructions
13-23 Revised 6-2010
A. Taxpayer FEIN/SSN
B. Reporting Period
C. Due Date
D. Permit Number
0 1
M M D D
H. Page
of
Page(s)
Mailing
Business
G. Out of Business
F.C.
P.T.
-Office Use Only
F. Address Change
E. Mailing Address
----Dollars ----
Cents
0 0
1. Total Sales (Whole dollars only) ..........
2. Removed from inventory and con-
+
sumed or used or purchases
0 0
for which direct payment is due ......
3. Total Exemptions
–
0 0
(Total from Schedule N. below) .......
=
4. Net Taxable Sales ...........................
0 0
=
5. State Tax ...................................
City and County Tax Computation
I. City/County Code
J. City/County Name
K. Net Sales Subject to Tax
L. Tax Rate (%)
M. Amount of Tax Due (Multiply Item K by Item L)
---Whole Dollars Only---
----Dollars ----
Cents
6
7
8
9
10
11
12
13
N. Sales Tax Exemption Schedule
Whole Dollars Only
----Dollars ----
Cents
3a. Sales to Those Holding Sales
14. Total Lines 6 through 13 ...................
Tax Permits or Direct Pay Permits ...
3b. Gasoline Sales with State
15. Total from Supplement Pages ..........
Gasoline Tax Paid ............................
3c. Motor Vehicle Sales on which
16. Tax Due
Excise Tax Has Been Paid ..............
(Add Lines 5, 14 and 15) ..................
17. Discount - Limit $2,500.
–
3d. Agricultural Sales .............................
...
(Discount not allowed for direct pay)
3e. Sales Subject to Federal Food
+
Stamp Exemption ............................
18. Interest..........................................
3f. Returned Merchandise ....................
+
19. Penalty..........................................
3g. Other Legal Sales Tax Exemptions
20. Less Approved Credit
–
(explain on reverse) .........................
(Attach Credit Voucher) ................
21. Total Due
=
(If No Total Due put ‘0’) .................
I declare that the information in this document and any attachments is true
and correct to the best of my knowledge and belief.
Use this form ONLY if you are required to remit taxes
before you received preprinted, preaddressed forms.
Sign
Here:
Date