Form 01-153 - Texas Customs Broker Report (Outlet Supplement)

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01-153
PRINT FORM
CLEAR FIELDS
b.
(1-04)
61100
Page _____ of _____
a. T Code
DO NOT WRITE IN SHADED AREAS
TEXAS CUSTOMS
c. Taxpayer number
d. Filing period
f. Due date
e.
BROKER REPORT
OUTLET SUPPLEMENT
g. Taxpayer name
You must contact the Texas State Comptroller's field office in your area with outlet location changes or name changes.
A license fee will be required for all new locations.
Physical location (outlet) name and address (Do not use a P.O. box address.)
Outlet
TOTALS FROM
no.
THIS OUTLET
(Dollars & cents)
1. Total value of the tangible personal property
1.
2. Total amount of the corresponding tax for which the Customs Broker issued certifications of export
2.
3. Total amount of tax refunded in accordance with certifications of export
3.
Physical location (outlet) name and address (Do not use a P.O. box address.)
Outlet
TOTALS FROM
no.
THIS OUTLET
(Dollars & cents)
1. Total value of the tangible personal property
1.
2. Total amount of the corresponding tax for which the Customs Broker issued certifications of export
2.
3. Total amount of tax refunded in accordance with certifications of export
3.
Physical location (outlet) name and address (Do not use a P.O. box address.)
Outlet
TOTALS FROM
no.
THIS OUTLET
(Dollars & cents)
1. Total value of the tangible personal property
1.
2. Total amount of the corresponding tax for which the Customs Broker issued certifications of export
2.
3. Total amount of tax refunded in accordance with certifications of export
3.
Physical location (outlet) name and address (Do not use a P.O. box address.)
Outlet
TOTALS FROM
no.
THIS OUTLET
(Dollars & cents)
1. Total value of the tangible personal property
1.
2. Total amount of the corresponding tax for which the Customs Broker issued certifications of export
2.
3. Total amount of tax refunded in accordance with certifications of export
3.
Physical location (outlet) name and address (Do not use a P.O. box address.)
Outlet
TOTALS FROM
no.
THIS OUTLET
(Dollars & cents)
1. Total value of the tangible personal property
1.
2. Total amount of the corresponding tax for which the Customs Broker issued certifications of export
2.
3. Total amount of tax refunded in accordance with certifications of export
3.
Total amount of the corresponding tax for
Total amount of tax refunded
Total value of the tangible
which the Customs Broker issued
in accordance with
personal property
TOTALS
certifications of export
certifications of export
FOR THIS
4a.
4b.
4c.
PAGE ONLY
You have certain rights
under Ch. 559, Government Code, to review, request, and correct information we have on file about you.
Contact us at the address or toll-free number listed on your report.

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