Arizona Transaction Privilege, Use and Severance Tax Return

Transaction Privilege, Use and Severance Tax Return
TRANSACTION PRIVILEGE, USE, AND SEVERANCE TAX RETURN - (TPT-EZ)
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TRANSACTION PRIVILEGE, USE, AND SEVERANCE TAX RETURN - (TPT-EZ)
Arizona Department of Revenue

PO Box 29010 - Phoenix, AZ 85038-9010
For assistance out of state or in the Phoenix area: (602) 255-3381 or
Statewide, toll free area codes 520 and 928: (800) 352-4090
	

Form TPT-EZ is for filing
periods beginning on or
after June 1, 2016.

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Page 1

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TPT-EZ return is due the 20th day of the month following
the month in which the transactions were conducted
TAXPAYER IDENTIFICATION NUMBER	

 SSN 	  EIN

	
LICENSE NUMBER

TAXPAYER INFORMATION

 AMENDED RETURN	
	

BUSINESS NAME

 FINAL RETURN	

 CHECK HERE AND SIGN BELOW IF YOU

(Cancel License) 	

HAVE NO GROSS RECEIPTS TO REPORT

PERIOD ENDING

M M D D Y Y Y Y

M M D D Y Y Y Y

REVENUE USE ONLY. DO NOT MARK IN THIS AREA

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* Use the Blue PRINT buttons to print your completed
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DATE BUTTON:
RECEIVED DATE
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button.

C/O
MAILING ADDRESS
CITY

PERIOD BEGINNING

STATE

 ADDRESS CHANGED (MAILING ADDRESS ONLY)

ZIP CODE
BUSINESS PHONE NUMBER

AA NET AZ/COUNTY TAX (PAGE 2, LINE 7, COLUMN (M))...........................................................................................................................................................................................................	 AA

0.00

A1 STATE EXCESS TAX COLLECT..........................................................................................................................................................................................................................................	 A1

A2 EXCESS TAX ACCOUNTING CREDIT ................................................................................................................................................................................................................................	 A2
A3 SUBTOTAL (LINE AA + A1 – A2 = NET/AZ COUNTY TAX)................................................................................................................................................................................................	 A3

BB

NET CITY TAX (PAGE 2, LINE 14, COLUMN (M))......................................................................................................................................................................................................................	BB

0.00

B1 CITY EXCESS TAX COLLECTED........................................................................................................................................................................................................................................	 B1
B2 SUBTOTAL (LINE BB + B1 = NET CITY TAX).....................................................................................................................................................................................................................	 B2

CC
DD
EE

NET TAX DUE ON THIS RETURN (LINE A3 + LINE B2 = LINE CC).........................................................................................................................................................................................	CC

TPT ESTIMATED PAYMENTS TO BE USED ON THIS RETURN (JUNE RETURN ONLY, DUE IN JULY)...............................................................................................................................	DD

TAX DUE NET OF TPT ESTIMATED PAYMENTS (LINE CC - LINE DD = LINE EE).................................................................................................................................................................	 EE

TOTAL AMOUNT REMITTED WITH THIS RETURN..................................................................................................................................................................................................................	 FF

$
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and
complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
	 The taxpayer designates the individual listed below as the person to contact to schedule an audit of
	 this return and authorizes the disclosure of confidential information to this individual.
FF

	

TAXPAYER PRINTED NAME

	

	

TAXPAYER SIGNATURE

	

TAXPAYER PHONE NO.

	

	

	

	

	

	

PAID PREPARER’S PRINTED NAME (OTHER THAN TAXPAYER)		PAID PREPARER’S TIN	

DATE

	

TITLE

PAID PREPARER’S SIGNATURE (OTHER THAN TAXPAYER)		
PAID PREPARER’S PHONE

PLEASE MAKE CHECK PAYABLE TO: ARIZONA DEPARTMENT OF REVENUE
ADOR 11263 (7/16) 	

	

TRANSACTION PRIVILEGE, USE, AND SEVERANCE TAX RETURN - (TPT-EZ)	

LICENSE NUMBER:

	

Page 2

STATE (AZ) /COUNTY TRANSACTION DETAIL (See Table 1 on the Tax Rate Table, www.azdor.gov)

	

(A)

(B)

(C)

REG.
CODE

NAME OF
REGION

(D)

(E)

(F)

BUS.
DESC. OF
CODE BUS. ACTIVITY

(G)
DEDUCTIONS
FROM
SCHEDULE A

GROSS
RECEIPTS

(H)

(I)
AZ /
COUNTY
TAX RATE

(F) - (G) = (H)
NET TAXABLE

(J)

(K)
ACCTNG
CREDIT
RATE

(H) X (I) = (J)
TOTAL TAX

(L)
(H) X (K) = (L)
ACCOUNTING
CREDIT

(M)
(J) - (L) = (M)
AZ/COUNTY
TAX DUE

1
2
3
4
5
6
7 AZ/COUNTY SUBTOTAL (AMOUNT IN COLUMN M,
MUST EQUAL PAGE 1, LINE AA).....................................

0.00

CITY TRANSACTION DETAIL (See Table 2 on the Tax Rate Table, www.azdor.gov)

	

(A)

(B)

(C)

LOC. CITY
CODE CODE

NAME OF CITY

(D)

(E)

BUS.
DESC. OF
CODE BUS. ACTIVITY

(F)
GROSS RECEIPTS

(G)
DEDUCTIONS
FROM
SCHEDULE A

(H)

(I)
CITY
TAX
RATE

(F) - (G) = (H)
NET TAXABLE

(J)

(K)

(H) X (I) = (J)
TOTAL TAX

(L)

(M)
(J) - (L) = (M)
CITY
TAX DUE

CITY
CREDIT

8
9
10
11
12
13
14 CITY SUBTOTAL (AMOUNT IN COLUMN M, MUST EQUAL PAGE 1,
LINE BB)..................................................................................................

0.00

NOTE: The deduction amounts that have been listed on the lines in column G must be itemized by category for each region code and business code reported.
	
The total of the amounts listed in Schedule A must equal the total of the Deduction Amounts listed in column G.

	
	

SCHEDULE A - DEDUCTION DETAIL INFORMATION

	

STATE (AZ) /COUNTY DEDUCTIONS DETAIL
(A)

(B)

(C)

(D)

REGION BUS. DEDUCTION
CODE CODE
CODE
1
2
3
4
5
6

SCHEDULE A - DEDUCTION DETAIL INFORMATION

	

CITY DEDUCTIONS DETAIL

(E)

(F)

(A)

(B)

DEDUCTION AMOUNT

DESCRIPTION OF
DEDUCTION CODE

LOC.
CODE

CITY
CODE

$
$
$
$
$
AZ/COUNTY TOTAL DEDUCTIONS $

8
9
10
11
12
13

(C)

(D)

BUS. DEDUCTION
CODE
CODE

(E)

(F)

DEDUCTION AMOUNT

DESCRIPTION OF
DEDUCTION CODE

$
$
$
$
$
CITY TOTAL DEDUCTIONS.................. $
TOTAL MUST EQUAL TOTAL ON PAGE 2, LINE 14, COLUMN G

TOTAL MUST EQUAL TOTAL ON PAGE 2, LINE 7, COLUMN G

	

ADOR 11263 (7/16) 	

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