Do not staple or paper clip. Do not write in shaded areas.
d. Filing period
TEXAS DIRECT PAYMENT RETURN
c. Taxpayer number
Page 1 of
f. Due date
Taxpayer name and mailing address (Make corrections next to any incorrect information.)
PLEASE NOTE: You cannot file this return unless you hold a Texas Payment Permit, issued by the Comptroller's office.
Blacken this box if your mailing address has changed. Show changes 1. by the preprinted information. Blacken this box if you are no longer in business. Direct Write in the date you went 2. out of business. i.
PLEASE PRINT YOUR NUMERALS LIKE THIS
CLICK HERE MAKE COPIES FOR YOUR RECORDS
INSTRUCTIONS FOR COMPLETING TEXAS DIRECT PAYMENT USE TAX RETURN WHO MUST FILE - Every person (sole owner, partnership, corporation or other organization) who is responsible for payment of Texas direct payment use tax must file a return. Failure to file this return and pay applicable tax may result in collection action as prescribed by Title 2 of the Tax Code. Returns and supplements must be filed for every period even if there is no tax due. WHEN TO FILE - Returns must be filed on or before the 20th day of the month following each reporting period. The due date for filing this return is printed in Item f. BUSINESS CHANGES - It is your responsibility to notify the Comptroller's office of any business changes or if you do not receive the correct forms to report your taxes. YES NO
More instructions on back.
WHOM TO CONTACT FOR ASSISTANCE - If you have any questions regarding the Direct Payment Use Tax, you may contact the Texas State Comptroller's field office in your area or call (800) 252-5555, toll free, nationwide. The Austin number is (512) 463-4600.
j. Are you taking credit to reduce taxes due on this return for taxes you paid in error on your own purchases?
Form 01-149 If you answered "YES" to question j, complete Form 01-149 and submit it with your return. 1. Amount subject to state tax (Taxable purchases on which tax was not paid to supplier. REPORT WHOLE DOLLARS ONLY.) 1.
27180 2a. 2. Total tax due
STATE TAX - Column a Multiply Item 1 by .062500 2b.
LOCAL TAX - Column b
Total of Item 7b on all list supplements
3. Prior payments (See instructions) 4. Net tax due (Item 2 minus Item 3) 5. Penalty and interest (See instructions.) 6. TOTAL STATE AND LOCAL AMOUNT DUE (Add Items 4 and 5.)
Mail to: COMPTROLLER OF PUBLIC ACCOUNTS P.O. Box 149354 Austin, TX 78714-9354
T Code Taxpayer number Period
6a. Total state amount due
6b. Total local amount due 04
7. TOTAL AMOUNT PAID
(Total of Items 6a and 6b. Make check payable to: STATE COMPTROLLER.) 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)
Form 01-119 (Back)(Rev.3-08/15)
INSTRUCTIONS FOR COMPLETING TEXAS DIRECT PAYMENT USE TAX RETURN (continued) GENERAL INSTRUCTIONS SPECIFIC INSTRUCTIONS Please do not write in shaded areas. If any preprinted information on this return is incorrect OR if you do not qualify to file this return, contact the Comptroller's office. You must file a return even if you had no purchases to report. If any amounts entered are negative, bracket them as follows:
NOTE: An additional $50 penalty will be assessed after more than two returns are received with a postmark date later than the due date.
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.