Form Lem28 - License/excise Tax Return - 2011

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DELAWARE DIVISION OF REVENUE
LEM28
LICENSE/EXCISE TAX RETURN - FORM LM1 9001
0028-01
ACCOUNT NUMBER
TAX PERIOD ENDING
DUE ON OR BE FORE
BUSINESS CODE GROUP DESCRIPTION
0-000000000-000
01-31-11
02-22-11
406 TIRE FEE
Reset
00280106000000000000001311102221100000000004060000000
Print Form
BUSINESS NAME AND ADDRESS
TAXABLE BASIS
0
_________________ X $2.00 = $________________
NUMBER OF TIRES SOLD
0
$
.00
AMOUNT DUE
Mail This Form With Remittance Payable To:
AUTHORIZED SIGNATURE
I declare under penalties of perjury, that this is
DATE
TELEPHONE NUMBER
Delaware Division of Revenue
a true, correct and complete return.
P.O. Box 2340, Wilmington, DE 19899-2340
For questions, call (302) 577-8780
If desired, provide an e-mail address where we may contact you regarding this return.
E-MAIL ADDRESS
CUT ALONG THIS LINE AND SEND THE ABOVE PORTION WITH ANY PAYMENT DUE
LICENSE/EXCISE TAX RETURN - MONTHLY
Complete the return above, sign, date and file by the due date. You may file all monthly or quarterly returns at the end of the year if no tax is
due on any of the returns.
To Update Your Contact/Business Information on File with Revenue:
Remit a License Request for Change form
To Change Tax Information You’ve Already Reported:
Remit an Amended return
SPECIFIC LINE INSTRUCTIONS
PLEASE NOTE: THE DIVISION OF REVENUE REQUIRES ROUNDING OF ALL AMOUNTS ON ALL GROSS RECEIPTS RETURNS.
Line 1. - Enter the total amount of Tires Sold for the month where indicated on the return.
Line 2. - Multiply this amount by $2.00 and enter the result in the Amount Due block.
Line 3. - This is the amount of tax due and payable with the filing of this return. Sign and date the return and provide your telephone number.
Cut along the line provided and mail the form with remittance due to the address on the return.
If you have not already renewed this year’s business license, do it now to avoid a $200 penalty.
Go to
to renew your business license online!
SAMPLE COMPLETED RETURN
TAXABLE BASIS
503
1,006.00
_________________X
$2.00 = $_____________
NUMBER OF TIRES SOLD
1,006
$
.00
AMOUNT DUE
Monthly Gross Receipts Tax Returns are due on or before the 20th day of the month following the end of the tax period.
MONTH END
DUE DATE
MONTH END
DUE DATE
MONTH END
DUE DATE
MONTH END
DUE DATE
01/31/2011
02/21/2011
04/30/2011
05/20/2011
07/31/2011
08/22/2011
10/31/2011
11/21/2011
05/31/2011
06/20/2011
08/31/2011
09/20/2011
11/30/2011
12/20/2011
02/28/2011
03/21/2011
06/30/2011
07/20/2011
09/30/2011
10/20/2011
12/31/2011
01/20/2012
03/31/2011
04/20/2011
For questions or to speak with a customer service representative, please call Revenue’s Gross Receipts Department at (302) 577-8780.
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