NEVADA DEPARTMENT OF TAXATION
Certificate No.: 002-
For Department Use Only
Mail Orig
inal To:
Nevada Department of Taxation
PO Box 7165
San Francisco, CA 94120-7165
Due on or before:
For Quarter ending:
A RETURN MUST BE FILED EVEN IF NO TAX LIABILITY EXISTS
ENTER AMOUNTS IN
COUNTY OF USE
AMOUNT SUBJECT TO USE TAX TAX RATE CALCULATED TAX
TAX CALCULATION
FORMULA
COLUMN A X COLUMN B = COLUMN C
01 CHURCHILL
02 CLARK
03 DOUGLAS
04 ELKO
05 ESMERALDA
06 EUREKA
07 HUMBOLDT
08 LANDER
09 LINCOLN
10 LYON
11 MINERAL
12 NYE
13 CARSON CITY
14 PERSHING
15 STOREY
16 WASHOE
17 WHITE PINE
TOTALS
18.
19.
20.
21.
22.
23.
24.
25.
26.
MAKE CHECKS PAYABLE TO NEVADA DEPARTMENT OF TAXATION
CONSUMER USE TAX RETURN
TXR-02.01
Revised 12/09/15
I HEREBY CERTIFY THAT THIS RETURN INCLUDING ANY ACCOMPANYING
SCHEDULE AND STATEMENTS HAS BEEN EXAMINED BY ME AND TO THE BEST
OF MY KNOWLEDGE AND BELIEF IS A TRUE, CORRECT AND COMPLETE
RETURN.
RETURN MUST BE SIGNED
_______________________________________________________________
SIGNATURE OF TAXPAYER OR AUTH. AGENT
_______________________________________________________________
TITLE PHONE NUMBER (WITH AREA CODE)
_______________________________________________________________
FEDERAL TAX IDENT NO. DATE
IF POSTMARKED AFTER DUE
DATE, PENALTY AND INTEREST
WILL APPLY
26. TOTAL AMOUNT REMITTED WITH RETURN
19. ENTER COLLECTION ALLOWANCE (0.5% OF LINE 18 IF TIMELY, 0% IF LATE)
20. NET TAXES (LINE 18 MINUS LINE 19)
18. TOTAL CALCULATED TAX (COLUMN C)
24. LESS CREDIT(S) APPROVED BY THE DEPARTMENT
23. PLUS LIABILITIES ESTABLISHED BY THE DEPARTMENT
22. INTEREST (1% OF LINE 20) FOR EA. MO. OR PART OF MO.PAST DUE
21. PENALTY (10% OF LINE 20)
25. TOTAL AMOUNT DUE AND PAYABLE
Due on or before: ________________
instructions
IF POSTMARKED AFTER DUE DATE,
PENALTY AND INTEREST WILL APPLY
If the name or address as shown is incorrect, if ownership
has changed, or if you are out of business, notify a
Department of Taxation District Office immediately.
IF LATE, ENTER NUMBER OF MONTHS______
see
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