Form 3 - Nebraska And Local Individual Use Tax Return

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FORM
Nebraska and Local Individual Use Tax Return
3
PLEASE DO NOT WRITE IN THIS SPACE
Social Security Number
NAME AND MAILING ADDRESS
RESET FORM
PRINT FORM
Name
Street or Other Mailing Address
City
State
Zip Code
1 Cost of taxable items or services purchased for use in Nebraska when Nebraska sales tax has not
00
been paid ......................................................................................................................................................
1 $
2 Nebraska use tax due (line 1 multiplied by .055) ..........................................................................................
2
Complete the following Local Use Tax Table (see instructions).
Local Use Tax Table
COLUMN A
COLUMN B
CITY OR COUNTY
LOCAL
LOCAL
Amount Subject to
Local Use Tax
TAX RATE
CODE
CLICK HERE FOR CURRENT CODES AND RATES
Local Use Tax
(Rate x Column A)
00
00
00
00
00
3 Total local use tax due (add amounts in Column B) .....................................................................................
3
4 Nebraska and local use tax due (line 2 plus line 3). Pay in full with this return. ............................................
4 $
I declare under penalties of law that I have examined this return, and to the best of my knowledge and belief, it is correct and complete.
sign
here
Taxpayer Signature
Signature of Preparer Other Than Taxpayer
Date
Date
(
)
(
)
Daytime Phone Number
Daytime Phone Number
Email Address
Email Address
Mail this return and payment to: NEBRASKA DEPARTMENT OF REVENUE, PO BOX 98923, LINCOLN, NE 68509-8923.
, 800-742-7474 (NE and IA), 402-471-5729
3-2013
6-090-1990 Rev.
Supersedes 6-090-1990 Rev. 3-2012

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