Form Pro 420 - Professional Privilege Tax Return For Professional Athletes
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1
2TENNESSEE DEPARTMENT OF REVENUE
PROFESSIONAL PRIVILEGE TAX RETURN - PROFESSIONAL ATHLETES
ACCOUNT NO.
FEIN
Filing
PRO
Period
420
LOCATION ADDRESS
Due
June 1, 2______
Date
}
If this is an AMENDED RETURN,
please check the box at right
Returns must be postmarked by the due
date to avoid the assessment of penalty
Name:
_________________________________________________________
and interest.
Make your check payable to the Tennes-
_________________________________________________________
Address:
see Department of Revenue for the amount
on Line 9 and mail to:
________________________________
State:
_____
Tennessee Department of Revenue
Zip:
__________
City:
Andrew Jackson State Office Bldg.
500 Deaderick Street
Nashville, TN 37242
Should you need assistance, please con-
tact the Taxpayer Services Division
by calling our statewide number at
Reminders
1-800-342-1003 or (615) 253-0600.
(1) Please read instructions on the back before preparing this return.
You may also visit our web site at
(2) Sign and date the return in the signature box below.
or
e-mail
(3) Attach a roster of players grouped by number of games played in Tennessee during the
professionpriv.help@tn.gov.
period. Maintain records to support the numbers reported on this return.
ROUND TO THE NEAREST DOLLAR
WRITE NUMBERS LIKE THIS
1. Number of players on team roster for only one game in Tennessee during the tax reporting period...............________ x 1........... (1)
2. Number of players on team roster for only two games in Tennessee during the tax reporting period.............________ x 2 ..........
(2)
3. Number of players on team roster for three or more games in Tennessee during the tax reporting period......________ x 3..........
(3)
4. Total number of game days in Tennessee during the reporting period (Add Lines 1, 2, and 3; enter here)...........................................
(4)
00
(5)
5. Total professional tax due (Multiply Line 4 x $2,500).........................................................................................
00
6. Credit reported on previous Department of Revenue credit notice(s)...............................................................
(6)
00
7. PENALTY (See instructions).............................................................................................................................
(7)
00
8. INTEREST
% (See instructions)..........................................................................................................
(8)
00
9. Total Amount Due (Add Lines 5, 7, and 8; subtract Line 6)..............................................................................
(9)
FOR OFFICE
USE ONLY
I declare this is a true, complete, and accurate return to the best of my knowledge.
SIGN
HERE
Principal Officer or Team Representative
Date
SIGN
HERE
Tax Return Preparer and Title
Date
INTERNET (01-10)
RV-R0012701
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