Form 01-116-A -Texas List Supplement - Sales And Use Tax

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CLEAR FIELDS
01-116-A
(Rev.3-08/13)
FFFF
Instructions in English
TEXAS LIST SUPPLEMENT
FILING REQUIREMENTS
- SALES AND USE TAX -
e.
d. Filing period
c. Taxpayer
26120
a.
number
f. Taxpayer name
g. Due date
PRINT YOUR NUMERALS LIKE THIS
Do not staple or paper clip.
Do not write in shaded areas.
2. CITY/TRANSIT/
3. AMOUNT SUBJECT TO TAX
5. AMT. OF TAX DUE
1. CITY/TRANSIT/COUNTY
4. TAX RATE
COUNTY/SPD NO.
/SPD NAME
(Whole dollars only)
(Multiply Item 3 by Item 4)
LOCAL TAX
7b. TOTAL DUE ON THIS PAGE
You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct
information we have on file about you. Contact us at the address or toll-free number listed on this form.

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