Local Retail Sales Tax Addendum
(Use this form if space on your tax return is not sufficient.)
Period
[45]
Year
Use Black Ink and Attach This Original Addendum to Your Return
Name:
Tax Registration Number
If you have business activity in more than one location, use the space below to show breakdown of income by city or county.
Group sales tax and use tax separately.
Report Local Use Tax/Deferred
Local Retail Sales Tax [45]
Sales Tax on page 2
Location Code
Taxable Amount
Local Rate
Tax Due City or County
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Total Tax Due
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Total Taxable
(Add totals from lines 1-18)
(The sum of taxable amounts from all location codes must equal the
Add all Addendum totals and transfer
the amount to the Total All Addendum
total taxable amount from State Retail Sales Tax on your return.)
line on your tax return.
Internet/Fax
(3-10-05)
Page
1