Form 01-116-C - Texas List Supplement - Direct Payment Use Tax
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1
201-116-C
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*01116C0W021515*
(Rev.2-15/15)
PRINT FORM
CLEAR FIELDS
Texas List Supplement
- DIRECT PAYMENT USE TAX
*** INTERNET ***
e.
d. Filing period
27120
c. Taxpayer
a.
number
f. Taxpayer name
g. Due date
PRINT YOUR NUMERALS LIKE THIS
Do not staple or paper clip.
Do not write in shaded areas.
1. CITY/TRANSIT/COUNTY
2. CITY/TRANSIT/
3. AMOUNT SUBJECT TO TAX
5. AMT. OF TAX DUE
(Whole dollars only)
(Multiply Item 3 by Item 4)
4. TAX RATE
COUNTY/SPD NO.
/SPD NAME
PLEASE NOTE:
You cannot file this supplement unless you hold a Texas Direct
Payment Permit, issued by the Comptroller's office.
CLICK HERE TO CONTINUE
**
Jurisdictions with two asterisks
**
(
) next to them indicates
LOCAL TAX
you have at least one outlet
within that jurisdiction. You
7b. TOTAL DUE ON THIS PAGE
must include the amount
You have certain rights
subject to tax for that outlet(s),
under Chapters 552 and 559, Government Code, to review, request and correct
even if the amount is zero.
information we have on file about you. Contact us at the address or phone number listed in the instructions.
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Parent category: Financial