Form 93 - Nebraska Tire Fee Return
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1
2Nebraska
FORM
n e
93
Tire Fee Return
de p
of
nebraska
DO NOT WRITE IN THIS SPACE
department
of revenue
Nebraska Identification Number
Reporting Period
RESET FORM
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
Check this box if you no longer sell tires at retail in Nebraska
1 Number of qualified tires sold.............................................................................................................
1
2 Number of qualified tires delivered outside Nebraska.................................. 2
3 Number of qualified tires sold to federal agencies ....................................... 3
4 Number of qualified tires sold for resale....................................................... 4
5 Total tires not subject to the fee (total of lines 2, 3, and 4) .................................................................
5
$
6 Tire fee at $1.00 per tire (line 1 minus line 5).....................................................................................
6
00
7 Previous balance with applicable interest at
% per year and payments received through
7
$
8 BALANCE DUE (line 6 plus line 7). Pay in full with return..................................................................
8
Under penalties of law, I declare that I have examined this return, and to the best of my knowledge and belief, it is correct and complete.
sign
here
Signature of Owner, Partner, Corporate Officer, or Duly Authorized Individual
Signature of Preparer Other Than Taxpayer
Title
Date
Address
Date
INSTRUCTIONS
tires at retail in Nebraska can cancel their license by placing
WHO MUST FILE. Every person making retail sales in
a check mark in the box above line 1.
Nebraska of new tires for farm tractors, motor vehicles,
trailers, or semitrailers must obtain a Nebraska Tire Fee
WHEN AND WHERETO FILE. This return, properly signed
License and file a Nebraska Tire Fee Return, Form 93. To
and accompanied by a check or money order payable to the
obtain a Nebraska Tire Fee License, you must complete
Nebraska Department of Revenue, is considered timely filed
a Nebraska Tax Application, Form 20. After issuing your
if U.S. postmarked on or before the twenty-fifth day of the
license, the department will mail preidentified returns to you
month following the reporting period covered by this return.
for each reporting period. Licensed retailers who no longer sell
A return is required for each reporting period even though no
THIS RETURN IS DUE ON OR BEFORE THE 25TH DAY OF THE MONTH FOLLOWING THE REPORTING PERIOD INDICATED ABOVE.
Mail this return and payment to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 94818, LINCOLN, NE 68509-4818
Have questions? Check our Web site: or call 1-800-742-7474 (in Lincoln, call 471-5729).
1-100-1990 Rev. 9-2006 Supersedes 1-100-1990 Rev. 5-2005
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