Form Tpt-1x - Amended Transaction Privilege, Use And Severance Tax Return
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1
2TRANSACTION PRIVILEGE, USE AND SEVERANCE TAX RETURN (TPT-1X)
.
STATE LICENSE NO
100
ARIZONA DEPARTMENT OF REVENUE
TAXPAYER IDENTIFICATION NO.
PO BOX 29010, PHOENIX, AZ 85038-9010
E I N
S S N
PERIOD COVERED
MAILING ADDRESS CORRECTION REQUESTED
FROM
THROUGH
THIS RETURN MUST BE FILED EVEN IF YOU HAD NO SALES
PAGE
OF
AMENDED
FILING FREQ
THESE AREAS FOR DEPARTMENT USE ONLY
TRAN
00
CODE
PAY
00
TYPE
ORIGINAL BD#
BUSINESS NAME: ________________________________________________
BD#
C/O: _______________________________________________________________
ADDRESS: _______________________________________________________
CITY/STATE/ZIP CODE: __________________________________________
POSTMARK
RECEIPT
Check if mailing address has changed
Check if mailing address has changed
COLUMN 3 X COLUMN 4 = COLUMN 5
COLUMN 3 X COLUMN 6 = COLUMN 7
COLUMN 1
COLUMN 2
COLUMN 3
COLUMN 4
COLUMN 5
COLUMN 6
COLUMN 7
L
R
Region
Bus.
I
Accounting
= Accounting
N
Class
C
-
=
Code
Gross
Deductions
Net Taxable
X Tax Rate
= Tax Amount
Business Description
Credit Rate
Credit
E
1
2
3
4
5
6
7
8
9
10
11
*** ***
SUBTOTAL
12
*
STATE EXCESS
13
TTT 09
ENTER EXCESS STATE TAX COLLECTED..........................
PLUS
(+)
*
OTHER EXCESS
14
TTT 10
ENTER OTHER EXCESS TAX COLLECTED.........................
PLUS
(+)
*
GRAND TOTAL
TTT 20
15
EQUALS (=)
16
ENTER ACCOUNTING CREDIT (see instructions).............
MINUS (-)
25
17
ENTER PENALTY AND INTEREST (see instructions)........
PLUS
(+)
30
ENTER TOTAL LIABILITY...................................................
18
35
EQUALS (=)
19
ENTER ADDITIONAL CREDIT TO BE USED.....................
MINUS (-)
43
50
20
MINUS (-)
ENTER AMOUNT PAID PREVIOUSLY...............................
If line 19 plus line 20 is greater than line 18
21
EQUALS (=)
55
ENTER AMOUNT TO BE REFUNDED................................
If line 19 plus line 20 is less than line 18
EQUALS (=)
22
99
ENTER NET AMOUNT YOU OWE......................................
Please make check payable to: ARIZONA DEPARTMENT OF REVENUE
FOR THIS AMOUNT
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Paid Preparer's Signature (other than taxpayer)
Paid Preparer's EIN or SSN
Taxpayer's Signature
Date
ADOR 64-1049 (3/96) TPT1-X
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