TEXAS SALES AND USE TAX RETURN
Do not staple or paper clip.
d. Filing period
Instructions in English
c. Taxpayer number
FORM 01-922 SEE INSTRUCTIONS FORM 01-922 Do not write in shaded areas. Page 1 of
e. f. Due date
Taxpayer name and mailing address
Blacken this box if your mailing address has changed. Show changes 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.
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 toll-free number listed on this form.
RETURN MUST BE FILED EVEN IF NO TAX IS DUE
j. Are you taking credit to reduce taxes due on this return for taxes you paid in error on your own purchases? (Blacken appropriate box) k. Did you refund sales tax for items exported outside the U.S. based on a Texas Licensed Customs Broker Export Certificate? (Blacken appropriate box)
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 to the Comptroller's office. PLEASE PRINT YOUR NUMERALS LIKE THIS
YES 1 YES 1
NO 2 NO 2
If you answered yes to either question j or k, you must complete Form 01-148 Form 01-148 and submit it with your return.
6. Physical location (outlet) name and address (Do not use a P.O. box address.)
1. TOTAL SALES (Whole dollars only) 2. TAXABLE SALES (Whole dollars only) 3. TAXABLE PURCHASES (Whole dollars only) 4. Amount subject to state tax (Item 2 plus Item 3) 5. Amount subject to local tax (Amount for city, transit, county and SPD must be equal.)
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 TAX RATES
7a.State tax (include in Item 8a)
7b.Local tax (include in Item 8b)
= LOCAL TAX - Column b
8. Total tax due (from all outlets or list supplements)
STATE TAX - Column a
9. Prepayment credit
_ = _ _ = + 15a. Total state amount due = 15b. Total local amount due
10. Adjusted tax due (Item 8 minus Item 9) 11. TIMELY FILING DISCOUNT 12. Prior payments 13. Net tax due (Item 10 minus Items 11 & 12) 14. Penalty and interest (See instructions) 15. TOTAL STATE AND LOCAL AMOUNT DUE
(Item 13 plus Item 14) Mail to: COMPTROLLER OF PUBLIC ACCOUNTS P.O. Box 149354 Austin, TX 78714-9354
T Code Taxpayer number
16. TOTAL AMOUNT PAID
(Total of Items 15a and 15b)
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)
Make check payable to: STATE COMPTROLLER.