Business & Occupation Activities Return - Department Of Revenue - 2015 Page 5
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5Local Sales & Use Tax Addendum
(Use this form if space on your tax return is not sufficient.)
Period
Year
4
Use Black Ink and Attach This Original Addendum to Your Return.
Name:
Tax Registration Number
Report Local Retail
4
Sales Tax on page 1.
Local Use Tax/Deferred Sales Tax [46]
Location Code
Value of Articles
Local Rate
Tax Due City or County
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Total Value
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Total Tax Due
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of Articles
(Add totals from lines 1-18)
(The sum of the Value of Articles from all location codes must equal
Add all Addendum totals and transfer
the amount to the Total All Addendums
gross amount from Use Tax/Deferred Sales Tax on your return.)
line on your tax return.
For tax assistance or to request this document in an alternate format, visit or call 1-800-647-7706. Teletype (TTY) users
may call (360) 705-6718.
Internet/Fax
Page 2
(9-26-12)
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