CUT ALONG BROKEN RULE
COLUMN A – 1-1/2%
COLUMN B – 2%
COLUMN C – 3%
COLUMN D – 4%
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1. (a) Gross sales – auto vehicles, truck trailers, semi-trailers, and house trailers . .
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Gross sales – farm machinery and equipment . . . . . . . . . . . . . . . . . . . . . . . . .
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Gross sales – machines and replacement parts used in manufacturing. . . . . .
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Cost price – food + food prods. sold for human consumption thru vend machs.
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Gross sales – all other property and Gross receipts – amusements . . . . . . . .
(b) Cost of property purchased at wholesale withdrawn for use. . . . . . . . . . . . . . .
(c) Collections during month on credit sales previously claimed as deduction. . . .
2. Total gross sales, withdrawals, collections (Total of items 1a, b, & c) . . . . . . . . .
3. TOTAL OF DEDUCTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. TOTAL AMOUNT REMAINING AS MEASURE OF TAX (item 2 minus item 3) . . . .
5. GROSS TAX (item 4 x rate shown at column heading) . . . . . . . . . . . . . . . . . . . . . .
6. (No.) _____________ of automotive vehicles withdrawn at $5.00 each (for automotive vehicle dealers only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8. DISCOUNT – IF PAID ON TIME
7. TOTAL AMOUNT OF TAX (Total item 5 Cols. A, B, C, D, & item 6) . . . .
5% on $100 or less in tax . . . . . . . . . . . . . .
9. LESS DISCOUNT FROM ITEM 8 (May not exceed $900.00) . . . . . . .
2% on tax over $100, if any . . . . . . . . . . . .
10. ADD PENALTY AND INTEREST, IF ANY (see instructions) . . . . . . . .
TOTAL DISCOUNT . . . . . . . . . . . . . . . . . . .
11. TOTAL AMOUNT DUE – Transfer to front of report . . . . . . . . . . . . . . . . .
Signed: ________________________________________________________________________
Date: _____________________________________________________________