Form St-115 - Consumer'S Use Tax Return

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Check Type of Return
Form ST-115
Indiana Department of Revenue
Annual
State Form 321
Consumer’s Use Tax Return
Quarterly
(R5/ 3-08)
Monthly
Period beginning (month/year) and ending (month/year)
Name
Tax Computation
Total purchases subject to tax
1.
.
Street Address
,
(from reverse side)..................
$
,
s
s
.
Use Tax
City or Post Office, County, State, and Zip Code
2.
,
,
(7% of Line 1)........................
s
s
Penalty (10% of Line 2) &
Principal Business Activity
Social Security Number
3.
.
Interest (call the Department*)
,
,
if paid after due date...............
s
s
Indiana TID #
ID Number
ID Type
.
Total amount due
Federal ID #
4.
(circle one)
$
,
,
(add Lines 2 and 3 )................
s
s
For Departmental Use Only
Signature & Title if other than individual return
Date
I declare under the penalties of perjury that to the best of my knowledge and belief, this is a true, cor-
*Call (317) 233-4015 or by e-mail at:
rect, and complete return.

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