Form Gro 204 - Gross Receiprs Tax Return - Mixing Bar Tax

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TENNESSEE DEPARTMENT OF REVENUE

GROSS RECEIPTS TAX RETURN - MIXING BAR TAX

FEIN or SSN

GRO

Due

Filing

Date

204

Period

ACCOUNT

Returns must be postmarked by the due

date. Returns must be filed even if no sales

were made or any tax due.

Make your check payable to the Tennessee

Department of Revenue for the amount

shown on Line 6 and mail to:

Tennessee Department of Revenue

Andrew Jackson State Office Building

500 Deaderick Street

Nashville, TN 37242

REMINDERS

1) Read instructions on reverse side before preparing this worksheet.

2) Fill out Schedule A on back of return and transfer the total to Line 1 of the worksheet below.

3) Transfer the amounts reported in the worksheet to the corresponding item numbers in the bottom portion.

4) Be sure to sign and date your return in the signature box on the back of the form.

WORKSHEET FOR COMPUTING TAX

ROUND TO NEAREST DOLLAR

1. TOTAL GROSS RECEIPTS (From Schedule A, Line 4 on back of return) .............................................................

___________________________

2. GROSS RECEIPTS TAX (

% of Line 1) ...........................................................................................................

___________________________

3. CREDIT MEMO BALANCE (If applicable) ...............................................................................................................

___________________________

4. PENALTY (Line 2 minus Line 3 multiplied by 5% for each 30-day period or portion thereof for which tax is late.

Maximum of 25%). Minimum penalty is $15 regardless of the amount of tax due or whether there is any tax due.

___________________________

5. INTEREST (Line 2 minus Line 3 multiplied by the current interest rate of

% per annum, from the due date to

the date paid) ...........................................................................................................................................................

___________________________

6. TOTAL AMOUNT REMITTED (Add Lines 2, 4, and 5; subtract Line 3 if applicable) ...............................................

___________________________

WRITE NUMBERS LIKE THIS

Keep Upper Portion For Your Records

Return Copy Below - Detach Here

TENNESSEE DEPARTMENT OF REVENUE

GRO

GROSS RECEIPTS TAX RETURN - MIXING BAR TAX

Due

Filing

204