Form E-500 - Sales And Use Tax Return

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Sales and Use Tax Return
E-500 (SD)
North Carolina Department of Revenue
MM DD YY
176453458
JOHN
Y
MM DD YY
QUARTERLY
N
AND JOHNSON PHARMACEUTICALS
INC
JOHNSON
5121
RALEIGHXXXXXXXX20MAX
NC
27605
VALDEZ
CTXXXXXXXXXXXXXXXX35MAX
000000000.00
000000000.00
000000000.00
000000000.00
00000000.00
000000000.00
x 4.5%
00000000.00
00000000.00
000000000.00
x 4%
00000000.00
00000000.00
000000000.00
x 3%
00000000.00
00000000.00
000000000.00
x 2%
00000000.00
000000000.00
x 1%
00000000.00
00000000.00
00000000.00
x 2%
00000000.00
00000000.00
000000000.00
00000000.00
00000000.00
00000000.00
00000000.00
00000000.00
00000000.00
00000000.00
00000000.00
00000000.00
Signature
Date
(
)
Phone
Title

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