Essential Information For St-3ez Page 2

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INFORMATION FOR SAMPLE RETURN AND WORKSHEET
FOR FORMS ST-3EZ
CAROLINIANA GROCERY & CONVENIENCE STORE
125 CAROLINA DRIVE
ALL AMERICA, USA
99999-9999
RETAIL LICENSE NO.: 047-12345-6 (LOCATION: COUNTY WITHOUT 1% LOCAL TAX)
FEI/SSN: 12-3456789
SALES AND PURCHASES FOR AUGUST 2006
Total Gross Proceeds of Sales
$74,000.00
Out-Of-State Purchases Subject to Use Tax
3,000.00
TOTAL
77,000.00
SUMMARY OF EXEMPT SALES
NON-TAXABLE SALES
Sales for Resale
$30,000.00
Sales to Federal Government
9,000.00
Sales Exempt During "Sales Tax Holiday"
1,000.00
TOTAL
40,000.00
2

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