Quarterly Return >

General Information

Name:

Address:

*For Period   to  

*Exact Date Business Started  

During Period Covered by Return

     *Quit business Yes  No  Exact Date

     *Sell or otherwise dispose of business Yes  No 

     Exact Date

Name and Address of New Owner:

*Type of Business:  

Computation of Taxes

A. Natural Gas (exemptions include deductions of $5000 annually)

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $3.60/$100 Value Taxes Due:  

B. Gross sales value manufactured products

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $.18/$100 Value  Taxes Due:  

C. Gross Income: Retailers, restaurants, and others

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $.30/$100 Value  Taxes Due:  

Wholesalers

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $.15/$100 Value  Taxes Due:  

D. Electric light and power companies

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $2.40/$100 Value Taxes Due:  

Natural gas companies

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $1.80/$100 Value Taxes Due:  

All other public utilities

Gross Amount:   Exemptions:

Taxable Amount:   Rate:$1.20/100 Value Taxes Due:  

E. Gross Income: Contracting Businesses

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $1.20/100 Value Taxes Due:  

F. Gross Income: Amusement Business

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $.30/$100 Value Taxes Due:  

G. Gross Income: Service and all other business

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $.60/ $100 Value Taxes Due:  

H. Gross Income: Rents, royalties, etc. Taxable to every person

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $.60/$100 Value Taxes Due:  

I. Banking and other financial institutions

Gross Amount:   Exemptions:

Taxable Amount:   Rate: $.72/$100 Value Taxes Due:  

Totals

*1) Total amount of taxes due:  

*2) Less Exemption  *  

     *($12/year; $3/quarter; no exemption after 60 days delinquent)

*3) Adjusted Tax (Line 1 Less Line2)  

*4) Penalty *  

     *( 5% first month or fraction and 1% each month or fraction thereafter)

*5) Previous balance  

*6) Total tax and penalty due  

*Preparer Name:  

By clicking this checkbox, I attest as the applicant that all information in this form is truthful to the best of my knowledge.