Form 51c - Nebraska County/city Lottery Tax Return - 1999

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Nebraska County/City Lottery Tax Return
FORM
• Returns must be filed every tax period even when no tax is due.
51C
• Read instructions on reverse side.
PLEASE DO NOT WRITE IN THIS SPACE
Nebraska Identification Number
Tax Period
RESET FORM
NAME AND LOCATION ADDRESS
NAME AND MAILING ADDRESS
COUNTY/CITY LOTTERY TAX (Counties, cities, and villages should complete lines 1 through 4 and Schedule I.)
$
1 Gross proceeds from lottery this quarter (from line 5 of Form 51C, Schedule I) ................................
1
00
$
2 Tax due (line 1 multiplied by .02) ........................................................................................................
2
00
3 Previous balance with applicable interest at
$
3% per year and payments received through
3
$
4 BALANCE DUE (line 2 plus or minus line 3). Pay in full with return ....................................................
4
00
Under penalties of law, I declare that I have examined this return, including accompanying schedules and statements, and to the best
of my knowledge and belief, it is correct and complete.
sign
here
Signature of Governing Official or Duly
Date
Signature of Preparer Other Than Taxpayer
Date
Authorized Individual
Title
Telephone
Address
E-Mail Address
THIS RETURN IS DUE ON OR BEFORE THE 30
TH
DAY OF THE MONTH FOLLOWING THE TAX PERIOD INDICATED ABOVE.
Mail the return and remittance to: NEBRASKA DEPARTMENT OF REVENUE, P.O. BOX 94855, LINCOLN, NE 68509-4855
7-2010
9-169-1999 Rev.
Make a copy for your file.
Supersedes 9-169-1999 Rev. 6-2009

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