
b
26180
b
STATE TAX - Column a
b
LOCAL TAX - Column b
8. Total tax due
(from all outlets or list supplements)
01-114
(Rev.4-19/40)
DDDD
_
9. Prepayment credit
10. Adjusted tax due
(Item 8 minus Item 9)
=
.
.
_
11. Timely filing discount (0.005)
. .
_
12. Prior payments
=
13. Net tax due (Item 10 minus Items 11 and 12)
. .
+
14. Penalty and interest
(See instructions)
. .
15a. Total state amount due 15b. Total local amount due
15. TOTAL STATE AND LOCAL AMOUNT DUE
(Item 13 plus Item 14)
=
b b
1. TOTAL
(Whole
2. TAXAB
(Whole
3. TAXAB
(Whole
4. Amount
to state
(Item 2
5. Amount
(Amoun
county
be equ
TEXAS SALES
dollars only)
b
LE SALES
dollars only)
b
LE PURCHASES
dollars only)
b
subject
tax
plus Item 3)
b
subject to local tax
t for city, transit,
and SPD must
al.)
b
7. AMOUNT OF TAX DUE FOR THIS OUTLET (Dollars and cents)
(Multiply "Amount subject to tax" by "TAX RATE" for state and local tax due)
TAX RATES
X
X
7a.State tax (include in Item 8a)
=
7b.Local tax (include in Item 8b)
=
j. Are you taking credit to reduce taxes due on this
return? If you are claiming bad debt credit to reduce
YES NO
your tax due, you must file electronically.
1 2
k. Did you refund sales tax for items exported outside
the U.S. based on a Texas Licensed Customs
YES NO
Broker Export Certificate?
(Blacken appropriate box)
1 2
DDDD
b.
*0111400W041940*
a.
c. Taxpayer number
d. Filing period e. f. Due date
Blacken this box if your mailing
Taxpayer name and mailing address
address has changed. Show changes
g. by the preprinted information.
1.
Blacken this box if you are no longer
in business. Write in the date you went
out of business.
2.
Blacken this box if one of your
locations is out of business or has
changed its address.
3.
h. i.
Page 1 of
01-114
(Rev.4-19/40)
Texas Sales and Use Tax Return
See instructions, Form 01-922.
26100
Do not staple or paper clip.
Do not write in shaded areas.
You have certain rights
under Chapters 552 and 559, Government Code, to review, request and correct
information we have on file about you. Contact us at the address or phone numbers indicated in the instructions.
l.
l.
NO SALES -
If you had zero to report in Items 1, 2 and 3 for ALL locations
1
for this filing period, blacken this box, sign and date this return and mail it
R
to the Comptroller's office.
PLEASE PRINT YOUR
NUMERALS LIKE THIS
Return MUST be filed even if no tax is due.
6. Physical location (outlet) name and address
Outlet
(Do not use a P.O. box address.)
no.
Taxpayer name
n.
I declare that the information in this document and any attachments is true and correct to the best of my knowledge.
Taxpayer or duly authorized agent
Date
Daytime phone
(Area code & number)
T Code Taxpayer number Period
16. TOTAL
AMOUNT PAID
26020
(Total of Items
15a and 15b)
If you answered yes to either question j or k, you must complete
Form 01-148 and submit it with your return.
Mail to: Comptroller of Public Accounts
P.O. Box 149354
Austin, TX 78714-9354
Make check payable to:
STATE COMPTROLLER.