4
E-500
Sales and Use Tax Return
Web-Fill
North Carolina Department of Revenue
PRINT
CLEAR
10-04
Legal Name (First 24 Characters)
Period Beginning (MM-DD-YY)
Street Address
Period Ending (MM-DD-YY)
Account ID
City
State
Zip Code (5 Digit)
1.
North Carolina Gross Receipts
0.00
(Do not include tax collected)
0.00
2.
Sales for Resale
(Do not include on Line 3 below)
3.
Receipts Exempt From State Tax
0.00
(Include sales exempt from State tax such as food)
Tax Type
Purchases for Use
Receipts
Rate
Tax
0.00
0.00
0.00
4.
4.5% State Rate
+
x
4.5%
=
5.
3% State Rate
+
0.00
0.00
x
3%
=
0.00
6.
2.5% State Rate
0.00
0.00
x
2.5%
0.00
+
=
Modular Homes
7. 2% State Rate
0.00
+
0.00
x
2%
=
0.00
0.00
8.
1% State Rate
0.00
0.00
x
1%
+
=
9.
2% Food Rate
0.00
0.00
0.00
x
2%
=
+
0.00
10.
2.5% County Rate
0.00
0.00
x
2.5%
=
+
11.
1% Additional
0.00
0.00
0.00
x
1%
=
+
County Rate
12.
.5% Additional
0.00
0.00
0.00
x
.5%
=
+
County Rate
0.00
13.
Total State Tax
(Add Lines 4 through 8)
0.00
14.
Total County Tax
(Add Lines 9 through 12)
0.00
15.
Excess Collections
0.00
16.
Total Tax
(Add Lines 13 through 15)
0.00
17.
Penalty - State and County
0.00
18.
Interest - State and County
0.00
19.
Less Prepayments
0.00
20.
Less any Credit
)
(Attach explanation
$
21.
Total Due
(Add Lines 16 - 18, Minus Lines 19 and 20)
0.00
Signature:
Date:
I certify that, to the best of my knowledge, this return is accurate and complete.
Title:
Phone: (
)
MAIL TO: P.O. Box 25000, Raleigh, NC 27640-0700