Form Jt-1/uc-001 - Arizona Joint Tax Application Page 2

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JT-1/UC-001 (10/10)
Page 2
Section B: Transaction Privilege Tax (TPT)
1. Date Business Started in Arizona
2. Date Sales Began
3. What is your anticipated annual income for your fi rst twelve months of business?
*
*
4. Business Classes (Select at least one. See Section H for a listing of business classes on page 4)
*
5. TPT Filing Method
6. Does your business sell tobacco products?
7. Does your business sell new motor vehicle tires or
vehicles?
Yes
If yes,
Retailer
Cash Receipts
No
OR
Accrual
No
Distributor
Yes
(You will be required to fi le a TR-1.)
If yes, please check the months in which you intend to do business:
8. Are you a seasonal fi ler?
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Yes
No
9. Location of Tax Records (Street Address, City, State and ZIP code) Do not use PO Box or Route No.
*
10. Name of Company or Person to Contact
11. Phone Number
For additional locations, complete the following: (If more space is needed, please attach additional sheets)
12. “Doing Business As” Name for this Location
13. Phone Number
(
)
14. Physical Location Address (Do not use PO Box or Route No.)
15. City
16. County
17. State
18. ZIP code
19. “Doing Business As” Name for this Location
20. Phone Number
(
)
21. Physical Location Address (Do not use PO Box or Route No.)
22. City
23. County
24. State
25. ZIP code
Section C: Program Cities / License Fees Below is a list of cities and towns licensed by the Arizona Department of Revenue.
City/Town
Code
Fee
No. of
Total
City/Town
Code
Fee
No. of
Total
City/Town
Code
Fee
No. of
Total
Loc
Loc
Loc
Benson
BS
5.00
Hayden
HY
5.00
Sedona
SE
2.00
Bisbee
BB
1.00
Holbrook
HB
1.00
Show Low
SL
2.00
Buckeye
BE
2.00
Huachuca City
HC
2.00
Sierra Vista
SR
1.00
Jerome
JO
2.00
Snowfl ake
SN
2.00
Camp Verde
CE
2.00
Kearny
KN
2.00
Somerton
SO
2.00
Carefree
CA
10.00
Kingman
KM
2.00
South Tucson
ST
2.00
Casa Grande
CG
2.00
Lake Havasu
LH
5.00
Springerville
SV
5.00
Cave Creek
CK
20.00
Litchfi eld Park
LP
2.00
St. Johns
SJ
2.00
Chino Valley
CV
2.00
Mammoth
MH
2.00
Star Valley
SY
2.00
Clarkdale
CD
2.00
Clifton
CF
2.00
Marana
MA
5.00
Superior
SI
2.00
Colorado City
CC
2.00
Maricopa
MP
2.00
Surprise
SP
10.00
Coolidge
CL
2.00
Miami
MM
2.00
Taylor
TL
2.00
Cottonwood
CW
2.00
Oro Valley
OR
12.00
Thatcher
TC
2.00
Dewey/Humboldt
DH
2.00
Page
PG
2.00
Tolleson
TN
2.00
Duncan
DC
2.00
Paradise Valley
PV
2.00
Tombstone
TS
1.00
Eagar
EG
10.00
Parker
PK
2.00
Tusayan
TY
2.00
El Mirage
EM
15.00
Patagonia
PA
25.00
Wellton
WT
2.00
Eloy
EL
10.00
Payson
PS
2.00
Wickenburg
WB
2.00
Florence
FL
2.00
Pima
PM
2.00
Willcox
WC
1.00
Fountain Hills
FH
2.00
Pinetop/Lakeside
PP
2.00
Williams
WL
2.00
Fredonia
FD
10.00
Prescott Valley
PL
2.00
Winkelman
WM
2.00
Gila Bend
GI
2.00
Quartzsite
QZ
2.00
Winslow
WS
10.00
Gilbert
GB
2.00
Queen Creek
QC
2.00
Youngtown
YT
10.00
Globe
GL
2.00
Safford
SF
2.00
Yuma
YM
2.00
Goodyear
GY
5.00
Sahuarita
SA
5.00
Guadalupe
GU
2.00
San Luis
SU
2.00
4
Total of City Fees:
0.00
Please Note: City fees are subject to change (go to our website
for updates). For cities not listed above, please contact the cities
State Fees $40.00 X _____ Number of Locations:
0
$0.00
directly. Your license will not be issued until all fees are paid.
TOTAL Fees:
$0.00
ADOR 10194 (10/10)
Previous ADOR 74-4002

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