Personal Property Lease/rental Transaction Tax - 7550 Page 3
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6MARKING INSTRUCTIONS
MARKING INSTRUCTIONS
ACCOUNT NUMBER
REVISION NUMBER
• Use a black or blue ink pen only.
• Do not use pens with ink that soaks through the paper.
• Print clearly, using all CAPITAL letters.
Owner/Officer Statement
Under penalty of perjury, I certify that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete.
FIRST NAME
LAST NAME
PHONE NUMBER
DATE
SIGNATURE (REQUIRED)
TITLE
Preparer Statement
Under penalty of perjury, I certify that I have examined this return, and to the best of my knowledge and belief, it is true, correct and complete.
FIRST NAME
LAST NAME
PHONE NUMBER
DATE
AGENT/PAID PREPARER SIGNATURE (REQUIRED)
BUSINESS NAME
F.E.I.N.
PHONE
NOTE: YOU MUST FILL THIS FORM OUT COMPLETELY. IF ANY INFORMATION IS OMITTED, THIS RETURN WILL BE DEEMED
INCOMPLETE, AND YOU WILL BE ASSESSED ADDITIONAL PENALTIES. ACCOUNT NUMBER MUST BE ENTERED.
For DOR Use Only
Postmark Date
Receipt Number
755001309
Page 3
V1 010509
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