You have certain rights under Chapters 552 and 559, Government Code, to
TEXAS CUSTOMS BROKER REPORT
c. Taxpayer number
review, request and correct information we have on file about you. Contact us at the address or toll-free number listed on your report. e. d. Filing period
Page 1 of
f. Due date
g. Name and mailing address (Make any necessary name or address changes below.)
Blacken this box if your mailing address has changed. Show changes by preprinted information. Blacken this box if you are no longer in business, and enter the date you went out of business below. Month Day
DO NOT WRITE IN SHADED AREAS.
INSTRUCTIONS WHO MUST FILE: DEFINITIONS: A person who is licensed by the United States Customs Service to act as a "Total value of the tangible personal property" means the total amount custom house broker and who holds a Texas Customs Broker License of all sales prices, as shown on receipts and invoices from retailers who sold the property for which the licensed customs broker issued certifications issued by the Comptroller's office. for export. WHEN TO FILE: for which the Customs Broker The due date of the quarterly report is the 20th day of the month following "Total amount of the corresponding taxthe total amount of all state and issued certifications of export" means the quarterly reporting period. For example, the first quarterly report of a local sales and use taxes for Texas, as shown on receipts and invoices year covers the months of January, February, and March and the due date from retailers who sold the property for which the licensed customs broker is April 20th. If the due date falls on a Saturday, Sunday or legal holiday, issued certifications of export. the next business day will be the due date. Failure to receive the correct "Total amount of tax refunded in accordance with certifications of report form from the Comptroller does not relieve a customs broker of the export" means the total amount of all state and local sales and use taxes responsibility to file a report on time by the due date. To be considered for Texas which the licensed customs broker obtained assignments of right timely filed, a report must be either postmarked or received by the of refund from purchasers and received refunds of taxes from retailers. Comptroller on or before the due date.
You must contact the Texas State Comptroller's field office in your area with outlet location changes or name changes. A license fee will be required for all new locations.
Physical location (outlet) name and address (Do not use a P.O. box address.)
TOTALS FROM THIS OUTLET
(Dollars & cents)
1. Total value of the tangible personal property 2. Total amount of the corresponding tax for which the Customs Broker issued certifications of export 3. Total amount of tax refunded in accordance with certifications of export 4. TOTALS FOR ALL OUTLETS
1. 2. 3. Total amount of tax refunded in accordance with certifications of export
Total value of the tangible personal property 4a.
Total amount of the corresponding tax for which the Customs Broker issued certifications of export 4b. 4c.
5. PENALTY: A penalty of $500 is imposed for each occurrence in which a licensed customs broker fails to file a quarterly report on or before the due date. The Comptroller may also impose an additional $50 late filing penalty for each late report filed if the customs broker has filed two previous late reports. 6. TOTAL AMOUNT DUE AND PAYABLE (Total of Item 5)
Taxpayer name T Code Taxpayer number Period
I declare that the information in this document and any attachments is true and correct to the best of my knowledge and belief. Taxpayer or duly authorized agent Make the amount in Item 6 payable to: STATE COMPTROLLER Mail to: COMPTROLLER OF PUBLIC ACCOUNTS P.O. Box 149354 Austin, TX 78714-9354 Daytime phone Date
If you have any questions regarding this form, you may contact the Texas State Comptroller's field office in your area or call (800) 252-5555, toll free, nationwide. The local number in Austin is (512) 463-4600.