Form Cat-103 - County Admissions Tax Return

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CAT-103
Indiana Department of Revenue
State Form 25341
County Admissions Tax Return
I.C. 6-9-13-1
(R2 / 3-13)
Your FID# (Federal Identifi cation Number)
-
___________________________________________
Tax Period (Month and Year)
___________________________________________
___________________________________
Due Date
County
(Due before 15th of the month following collection.)
Name of Taxpayer _________________________________________________________________________________
Address _________________________________________________________________________________________
City __________________________________
State ____________________
Zip ______________________
A. Enter total admissions for professional sporting events for
____________
$ _______________________
Month/Year
B. Enter county admissions tax due (10% of Line A)
$ _______________________
C. Total Amount Due
$ _______________________
Please make check payable to the:
Indiana Department of Revenue
Payments must be made with U.S. funds.
Please do not include check stubs when mailing your payments.
Mail to: Indiana Department of Revenue
100 N Senate Ave IGCN 140
Indianapolis, IN 46204
I declare under the penalty of perjury that this is a true, correct and complete return.
__________________________________________
_____________________
________________________
Signature/Title
Date
Phone
This Return Must Be Filed Even If No Tax Is Due

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