Form Jt-1/uc-001 - Arizona Joint Tax Application - 2015 Page 2
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4JT-1/UC-001 (4/15)
Page 2
Section B: Transaction Privilege Tax (TPT)
*
*
1. Date Business Started in Arizona
2. Date Sales Began
3. What is your anticipated annual income for your first twelve months of business?
4. TPT Filing Method
5. Does your business sell tobacco products?
6. Does your business sell new motor vehicle tires or
vehicles?
o
Yes
If yes,
o
Retailer
o
Cash Receipts
o
No
OR
o
Accrual
o
o
o
No
Distributor
Yes
(You will be required to file a TR-1.)
If yes, please check the months in which you intend to do business:
7. Are you a seasonal filer?
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
o
o
Yes
No
*
8. Location of Tax Records (Street Address, City, State and ZIP code) Do not use PO Box or Route No.
9. Name of Company or Person to Contact
10. Phone Number
(
)
For additional locations, complete the following: (If more space is needed, please attach additional sheets)
12. Phone Number
11. “Doing Business As” Name for this Location
(
)
13. Physical Location Address (Do not use PO Box or Route No.)
14. City
15. County
16. State
17. ZIP code
19. Phone Number
17. “Doing Business As” Name for this Location
(
)
20. Physical Location Address (Do not use PO Box or Route No.)
21. City
22. County
23. State
24. ZIP code
Section C: Program Cities / License Fees Below is a list of cities and towns licensed by the Arizona Department of Revenue.
No. of
City/Town
Code
Fee
Total
Fee
Total
City/Town
Code
Fee
Total
No. of
City/Town
Code
No. of
Loc
Loc
Loc
Benson
BS
5.00
Guadalupe
GU
2.00
Sahuarita
SA
5.00
Bisbee
BB
1.00
Hayden
HY
5.00
Show Low
SL
2.00
Buckeye
BE
2.00
Holbrook
HB
1.00
Sierra Vista
SR
1.00
Huachuca City
HC
2.00
Snowflake
SN
2.00
Bullhead City
BH
2.00
Jerome
JO
2.00
Somerton
SO
2.00
Camp Verde
CE
2.00
Kearny
KN
2.00
South Tucson
ST
2.00
Carefree
CA
10.00
Kingman
KM
2.00
Springerville
SV
5.00
Casa Grande
CG
2.00
St. Johns
SJ
2.00
Lake Havasu
LH
5.00
Cave Creek
CK
20.00
Litchfield Park
LP
2.00
Star Valley
SY
2.00
Chino Valley
CV
2.00
Mammoth
MH
2.00
Superior
SI
2.00
Clarkdale
CD
2.00
Marana
MA
5.00
Surprise
SP
10.00
Clifton
CF
2.00
Maricopa
MP
2.00
Taylor
TL
2.00
Colorado City
CC
2.00
Miami
MM
2.00
Thatcher
TC
2.00
Coolidge
CL
2.00
Oro Valley
OR
12.00
Tolleson
TN
2.00
Cottonwood
CW
2.00
Page
PG
2.00
Tombstone
TS
1.00
Dewey/Humboldt
DH
2.00
Paradise Valley
PV
2.00
Tusayan
TY
2.00
Duncan
DC
2.00
Parker
PK
2.00
Wellton
WT
2.00
Eagar
EG
10.00
Patagonia
PA
25.00
Wickenburg
WB
2.00
El Mirage
EM
15.00
Payson
PS
2.00
Willcox
WC
1.00
Eloy
EL
10.00
Pima
PM
2.00
Williams
WL
2.00
Florence
FL
2.00
Pinetop/Lakeside
PP
2.00
Winkelman
WM
2.00
Fountain Hills
FH
2.00
Prescott Valley
PL
2.00
Winslow
WS
10.00
Fredonia
FD
10.00
Quartzsite
QZ
2.00
Youngtown
YT
10.00
Gila Bend
GI
2.00
Queen Creek
QC
2.00
Yuma
YM
2.00
Gilbert
GB
2.00
Safford
SF
2.00
Globe
GL
2.00
San Luis
SU
2.00
Goodyear
GY
5.00
4
Please Note: City fees are subject to change (go to
Total of City Fees:
our website for updates). For cities not listed above,
State Fees $12.00 X _____ Number of Locations:
please contact the cities directly. Your license will not
TOTAL Fees:
be issued until all fees are paid.
ADOR 10194 (5/15)
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