Massachusetts Individual Use Tax Return

Individual Use Tax Return
ST-11
Massachusetts Department of Revenue
Individual Use Tax Return

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Rev. 7/09

D E PA R

FORM ST-11

R

Name

Social Security number

Address

State

Zip

Return is due with payment on or before April 15 for purchases made
in the prior calendar year. Make check payable to the Commonwealth
of Massachusetts. Mail to: Massachusetts Department of Revenue,
PO Box 7009, Boston, MA 02204.

I declare under the penalties of perjury that this return has been
examined by me and to the best of my knowledge and belief is a
true, correct and complete return.
Signature

1. Year purchases made . . . . . . . . . . . . . 1
2. Total purchases from line 9 on
reverse. . . . . . . . . . . . . . . . . . . . . . . . . 2
3. Use tax (6.25% of line 2). . . . . . . . . . . 3
4. Total credit for sales/use tax paid
to other states or jurisdictions.
From line 10 on reverse. . . . . . . . . . . . 4
5. Balance. Subtract line 4 from line 3.
Not less than “0” . . . . . . . . . . . . . . . . . 5
6. Penalty. . . . . . . . . . . . . . . . . . . . . . . . . 6
7. Interest. . . . . . . . . . . . . . . . . . . . . . . . . 7
8. Total amount due. . . . . . . . . . . . . . . . . 8
Date

Date of
purchase

Name of seller,
city and state

Quantity and description
of property purchased

A. Sales
price

29. Total purchases. Add all of the purchase prices listed in column A.
Enter the result here and in line 2 on the front.
3 $
10. Total sales/use tax paid to other states or jurisdictions. Add all of the amounts listed in column B.
Enter the result here and in line 4 on the front.
3 $
Attach an additional statement if more space is necessary.

B. Sales/use tax paid
to other jurisdictions or
6.25% of sales price —
whichever is less