Form 9b - Nebraska Tire Fee Return For County Treasurers And Other Officials
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1
2Nebraska Tire Fee Return
FORM
9B
for County Treasurers and Other Officials
Nebraska ID Number
Tax Period
PLEASE DO NOT WRITE IN THIS SPACE
RESET FORM
COUNTY NAME AND MAILING ADDRESS
1 Nebraska tire fee collected during this tax period ............................................................................. 1
00
2 Previous balance due or credit (see instructions) ............................................................................. 2
c
Check this box if payment is being made electronically.
3 Balance due (line 1 plus or minus line 2). Pay in full with return ....................................................... 3
Under penalties of law, I declare that I have examined this return, and to the best of my knowledge and belief, it is correct and complete.
sign
here
Authorized Signature
Title
Date
This return is due on or before the 15th day of the month following the tax period indicated above.
Mail this return and payment to: Nebraska Department of Revenue, PO Box 94818, Lincoln, NE 68509-4818.
, 800-742-7474 (NE and IA), 402-471-5729
3-2013
1-101-1990 Rev.
Supersedes 1-101-1990 Rev. 2-2012
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Parent category: Financial