Form T-1 - Virginia Tire Tax Return, Form T-1a - Dealer'S Worksheet For Computing Tire Tax

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FORM T-1
VIRGINIA TIRE TAX RETURN
1. NUMBER OF
FOR PERIOD ENDING
TIRES SOLD
2d. TOTAL DEDUCTIONS
FILING DATE
3. ITEM 1 LESS ITEM 2d
I
4. TAX (Multiply Item 3
I
by $0.50)
5, DEALER'S 5%
I
DISCOUNT
.
ACCOUNT NUMBER
OUT OF BUSINESS - Indicate the date
I
6. ITEM 4 LESS ITEM 5
your business was terminated or sold
I
7. PENALTY FOR LATE
FILING AND PAYMENT
I
I
8. INTEREST FOR LATE
I
FILING AND PAYMENT
9. TOTAL TAX, PENALTY
I
AND INTEREST
I
MAKE CHECK OR MONEY ORDER
PAYABLE TO
VIRGINIA DEPARTMENT OF TAXATION
I declare that this return (including any accompanying schedules and statements) has been examined by
me and to the best of my knowledge and belief is a true, correct and complete return.
SIGNATURE
(
)
TELEPHONE NO.
DATE
Official form is smaller than the full page. Please trim
along dark lines before filing. Filing a form of the wrong
size may result in rejection of the form and the state
returning the form to you. Thank you.

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