Form Scu 20041 - Consumer Use Tax Return 'Supplement'

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SCU
20041
Revised 12-2012
Consumer Use Tax Return ‘Supplement’
Do Not Use This Form For Reporting Sales Tax
A. Taxpayer FEIN/SSN
B. Reporting Period
C. Due Date
D. Account Number
E. Amended Return
H. Page ________ of ________ Page(s)
Distribution of Tax for Cities/Counties Schedule
M. Amount of Tax Due
K. Net Taxable Purchases
(Multiply Item K by Item L)
L. Tax Rate
(%)
I. City/County Code
J. City/County Name
- - - Whole Dollars Only - - -
- - - Dollars - - -
Cents
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N. TOTAL City/County Tax (Line 16 through Line 45) (Add to Total on Item N. on Form SCU20004)
If more space is needed, use supplemental page(s)

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