Form Bet-03 - Bank Excise Tax Return

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NEVADA DEPT OF TAXATION
TID No:
-
Account No:
BANK EXCISE TAX RETURN
FOR DEPARTMENT USE ONLY
Mail to:
Postmark Date:
Nevada Department of Taxation
Amount:
Check #:
1550 College Parkway #115
Carson City NV 89706
For quarter:
to
Due on or before:
If postmarked after due date
penalty and interest will apply
*NOTE: PLEASE READ INSTRUCTIONS ON REVERSE SIDE BEFORE COMPLETING RETURN.
A RETURN MUST BE FILED EVEN IF NO TAX IS DUE*
1.
1.
TOTAL NUMBER OF QUALIFYING BRANCHES IN NEVADA (See Information on Reverse)
2.
2.
TAX DUE (MULTIPLY LINE 1 BY $1750)
3.
3.
LESS CREDITS APPROVED BY THE DEPARTMENT
4.
4.
TOTAL BANK EXCISE TAX DUE (LINE 2 MINUS LINE 3)
5.
5.
PENALTY (
For periods prior to April 1, 2007 the penalty is 10%)
INTEREST (
Note: 7/1/2011 interest rate change: To calculate interest for each month late
6.
after 7/1/2011, multiply Line 4 × 0.75% (or .0075). To calculate interest for each month late
6.
from 7/1/1999 through 6/30/2011, multiply Line 4 × 1% (or .01).
7.
7.
PLUS LIABILITIES ESTABLISHED BY THE DEPARTMENT
8.
8.
TOTAL AMOUNT DUE AND PAYABLE (ADD LINES 4 THROUGH 7)
9.
9.
TOTAL AMOUNT REMITTED WITH RETURN
THE BANK EXCISE TAX LIST OF ALL BRANCHES IN NEVADA (FORM BET-02) MUST BE FILED
WITH RETURN
I hereby certify that this return including any accompanying schedules and statements has been examined by me and to the
best of my knowledge and belief is a true, correct and complete return.
Signature
Name Of Preparer
Title
Federal Identification Number
Phone Number
Date
BET-03
REV 07/01/11

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