Form 14-115 - Texas Motor Vehicle Sales/use Tax And Surcharge Report
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1
214-115
b.
(Rev.6-03/6)
TEXAS MOTOR VEHICLE SALES/USE TAX AND SURCHARGE REPORT
17100
a.
DO NOT WRITE IN SHADED AREAS
e.
c. Taxpayer number
d. Filing period
f. Due date
g. Name and mailing address (Make any necessary name or address changes below. )
h. IMPORTANT
Blacken this box if your mailing address
has changed. Show changes
1.
by the preprinted information.
j.
i.
14100
17100
COL. I
COL. II
TAX CALCULATION
SURCHARGE CALCULATION
1A. .
1B.
1. Number of receipts issued
(Including Voids)
2A. .
2B.
2. Gross Motor Vehicle Sales and Use Tax collected
(Dollars & cents)
3A.
3B.
3. 2.5% Surcharge collected for model years 1996 and prior
(Dollars & cents)
4A.
4B.
4. 1.0% Surcharge collected for model years 1997 and later
(Dollars & cents)
5A.
5B.
5. Gross Surcharge collected
(Item 3B plus Item 4B)
6A. .
6B.
6. Claim for dishonored payment
7A. .
7B.
7. Commission not available from registration fees
8. Net motor vehicle ta x and/or surcharge collected
8A. .
8B.
(Item 2A minus Items 6A and 7A; Item 5B minus Items 6B and 7B)
9A. .
9B.
9. Interest earned
10A.
10B.
10. TOTAL AMOUNT DUE
(Item 8A plus Item 9A and Item 8B plus Item 9B)
14-115 (Rev.6-03/6)
11A.
11B.
11. Total amount of prepayments
12A.
12B.
12. Amount due
(Item 10A minus Item 11A and Item 10B minus 11B)
k.
l.
13.
13. TOTAL AMOUNT OF TAX AND SURCHARGE DUE AND PAYABLE
(Item 12A plus Item 12B)
Taxpayer name
m.
I declare that the in formation in this document and any attachments is true and correct to
T Code
Taxpayer number
Period
the best of my knowledge and belief.
Duly authorized agent (PLEASE PRINT N AME)
17920
Make the amount in Item 13 Mail to: COMPTROLLER OF PUBLIC ACCOUNTS
payable to:
111 E. 17th Street
Austin, Texas 78774-0100
STATE COMPTROLLER
Business phone
Date
If you have any questions regarding Motor Vehicle Sales and Use Tax or Surcharge
you may contact the Texas State Comptroller's field office in your area or call
1-800-252-1382 toll free nationwide. The local number in Austin is 512/463-4600. If
you are calling from a Telecommunications Device for the Deaf (TDD), the toll free
333 A
number is 1-800-248-4099, or in Austin, 512/463-4621
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