Form 15 - Wyoming Use Tax Return - 2001

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Wyoming Use Tax Return
Wyoming Use Tax Return
Department of Revenue
Department of Revenue
Herschler Bldg., 122 W. 25th St.
Herschler Bldg., 122 W. 25th St.
Cheyenne, WY
Cheyenne, WY
82002-0110
82002-0110
Form 15
Form 15
Department
Use ONLY
RID:
Ownership
Name:
@
PLEASE COMPLETE THIS FORM BY
Report Period:
through
02 0 12345
Feb 01, 1996
Feb 29, 1996
HAND - USE BLACK INK ONLY
MO
DAY
YR
MO
DAY
YR
1.
Gross purchases
2.
Total deductions
3.
Net taxable purchases
4. 4. Use Tax Due This Report Period:
Use Tax Due This Report Period:
Please write neatly inside the boxes!
Please write neatly inside the boxes!
Use Tax Due
Use Tax Due
Materials/Purchase Cost
Materials/Purchase Cost
Materials/Purchase Cost
Materials/Purchase Cost
Use Tax Due
Use Tax Due
X
X
Tax Rate
Tax Rate
= =
Tax Rate
Tax Rate
= =
County
County
4A.
4A.
County
County
4B.
4B.
4A.
4A.
4B.
4B.
4D.
4D.
4C.
4C.
4C.
4C.
4D.
4D.
6 %
5 %
Natrona
Albany
5 %
6 %
Niobrara
Big Horn
5.25 %
4 %
Park
Campbell
6 %
5 %
Platte
Carbon
5 %
6 %
Sheridan
Converse
5 %
4 %
Sublette
Crook
4 %
5 %
Sweetwater
Fremont
5 %
6 %
Teton
Goshen
5 %
6 %
Uinta
Hot Springs
5 %
4 %
Washakie
Johnson
6%
5 %
Weston
Laramie
5 %
4E. Total USE tax due
4E. Total USE tax due
Lincoln
(Columns 4D):
(Columns 4D):
5. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (This Line is not used) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
6.
Additional Tax Due .................................................................................................................
7. Reference Construction
Project Number(s):
8. Give consumer purchase description:
9.
TOTAL TAX DUE
(From Line 4E)
(From Line 4E)
10. Adjustments
(Mark one:
P & I
OR
CREDIT)
F
PAY THIS AMOUNT
PAY THIS AMOUNT
11. TOTAL DUE
TOTAL DUE
( (
) )
Lines 9 + 10
Lines 9 + 10
,
,
.
TO AVOID PENALTY AND INTEREST YOU MUST PAY THE TAX BY THE END OF THE MONTH FOLLOWING THE MONTH OF PURCHASE .
F F F
I declare, under penalty of perjury, that I have examined this return and to the best of my knowledge and belief it is correct and complete.
Rev. 1/01
Authorized
Signature
Title
FEIN/SSN
Date:
/
/
Phone No. (
)
-

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