Form Spt-1 - Maine Revenue Services Service Provider Tax - 2004

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*0441000*
SPT
Maine Revenue Services
00
Service Provider Tax
*0441000*
Registration No.
Business Code
Period Begin
Period End
Due Date
1. Entity Information
Use this area only to report changes in your business
2.
OUT OF BUSINESS?
Check here
, return permit to Bureau and
complete information at right. Date closed
3.
OWNERSHIP CHANGE?
If you have changed ownership, indicate the date
when this occurred here
and check off type of change below:
Incorporated
Partner added or dropped
Other (explain on reverse)
Sold to
ADDRESS CHANGE?: If your address above is incorrect, please
4.
NAME CHANGE?
Attach explanation to this return.
make the appropriate changes to the preprinted address.
Do Not Use Red Ink!
Gross Services
1.
,
,
.
Services
Deductions: Exempt Services 2.
,
,
.
Taxable Services (lines 1-2)
3.
,
,
.
Extended Cable TV Service
4.
,
,
.
Fabrication Services
5.
,
,
.
Video Rentals
6.
,
,
.
Breakdown
of Taxable
7.
,
,
.
Rent-to-Own
Services
Telecommunications Services 8.
,
,
.
Private Non-Medical
Institution
9.
,
,
.
Add lines 4, 5, 6, 7, 8 & 9.
Total
Total must agree with Line 3
10.
,
,
.
Services
Total Tax
Line 10 @ 5%
11.
,
,
.
Credits
Credit Carry Forward From Prior Period
12.
,
,
.
Amount Due
Line 11 less line 12. Use line 14 if the result is a credit amount.
13.
,
,
.
If Line 11 less line 12 is a credit amount, enter the amount to the right. If you wish a refund
Credit Due
rather than a carry forward to the next period, check here
14.
,
,
.
Mail To:
Maine Revenue Service
P.O. Box 1065
Augusta, ME 04332-1065
Signature/Title
Print Name
Date
Phone #
SPT-1 07/04

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