Form Tpt-1 Sample - Transaction Privilege And Use Tax Return Page 4
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5TRANSACTION PRIVILEGE AND USE TAX RETURN
Revenue Collections Operations
000XXXXXXXXXXX20XX
Licensing Office
55 North Center Street
License No.
XXXXXXX
Mesa Arizona 85201
Reporting Period
month/year
(480)644-2316
Fax(480)644-3999
Due Date
XX/20/XXXX
Taxpayer Business Name
Please indicate mailing address change here.
Taxpayer C/O
1
Taxpayer Address
Taxpayer City/State/ZIP Code
2
SPECIAL NOTICE
Check here and sign at the bottom
THIS RETURN IS DUE O N
3
THE 20TH OF THE MONTH
if you have no gross receipts to report.
Column 1
Column 2
Column 3
Column 4
Column 5
x Tax
Allowable pg 2
Business Description
Bus. Class
Gross
= Net Taxable
= Tax Amount
Rate
9
Line
- Deductions
1.75%
1
5
4
6
7
8
10
1.75%
2
1.75%
3
1.75%
4
1.75%
5
1.75%
6
11
USE TAX
20
1.75%
7
1.75%
TOTAL FROM ADDTL PAGES
8
12
SUBTOTAL
1.75%
9
13
(Total from Schedule B) EXCESS CITY TAX COLLECTED/JET FUEL
10
Plus
(+)
14
TOTAL TAX DUE
11
Equals (=)
15
(see instructions) PENALTY & INTEREST
12
Plus
(+)
16
ENTER TOTAL LIABILITY
13
Equals (=)
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(Total from Schedule B) CREDIT TO BE APPLIED
14
Minus (-)
18
ENTER NET AMOUNT DUE
15
Equals (=)
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ENTER TOTAL AMOUNT PAID
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my
knowledge and belief it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer
has any knowledge.
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T axpa ye r's S ig na ture
D a te
P aid P re pa re r's S ign ature
P rin t N a m e
P h on e #
P rin t P aid P re pa re r's N am e
A SIGNATURE IS REQUIRED TO MAKE THIS RETURN VALID
Mailing Address
Return original with remittance in envelope provided.
PO Box 16350
Please make check payable to: CITY OF MESA
Mesa Arizona 85211-6350
Complete both sides of form.
(TPT-1) (Rev. 09-05)
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