Form Atg20012 - Oklahoma Mixed Beverage Tax Return
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1
2ATG
20012
Revised 10-2012
Oklahoma Mixed Beverage Tax Return
E. Amended Return
A.Taxpayer FEIN/SSN
B. Reporting Period
C. Due Date
D. Account Number
01
H. Page ______ of ______ Page(s)
G. Mailing
Date Out
Address Change
of Business: __________________
MM/DD/YY
F. Out of Business
-Office Use Only-
G. New Mailing Address
_________________________________________________________
_________________________________________________________
Address
Name
_________________________________________________________
_________________________________________________________
City
State
ZIP
Address
_________________________________________________________
City
State
ZIP
- - - - - - - - - - - - Dollars - - - - - - - - - - - -
- - - Cents - - -
1. Total Gross Receipts for All Sites
00
(Total from Column K plus Column K supplement page[s]).......................................................1. _______________________________ . ____________
2. Total Taxable Admission Charges for All Sites
00
(Total from Column L plus Column L supplement page[s]) .........................................................2. _______________________________ . ____________
3. Total Tax Due (Total from Column M plus Column M supplement page[s]) ................................3. _______________________________ . ____________
4. Discount ................................................................................................................................. - 4. _______________________________ . ____________
5. Interest .................................................................................................................................. + 5. _______________________________ . ____________
6. Penalty (10%) ........................................................................................................................ + 6. _______________________________ . ____________
7. Total Due ............................................................................................................................... = 7. _______________________________ . ____________
Mixed Beverage Sales
K. Site Total Gross Receipts
L. Taxable Admission Charges
I. Site Number
J. ABLE Number
M. Site Tax Due
Rate
(Whole numbers only)
(Whole numbers only)
13.5%
8
13.5%
9
13.5%
10
13.5%
11
13.5%
12
13.5%
13
13.5%
14
13.5%
15
13.5%
16
13.5%
17
13.5%
18
(if more space is needed, use
N. TOTAL
Form 20121, Oklahoma Mixed Beverage
Tax Return Supplement)
Signature: _____________________________________________________
Date: ___________________________
The information contained in this return and any attachments is true and correct to the best of my knowledge.
The Oklahoma Tax Commission is not required to give actual notice of changes in any State tax laws.
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