Tax Category Nebraska and Local Sales and Use Tax Return · Ifapplicable,completeScheduleI on reverse side. · SeeoptionalNebraskaNetTaxableSalesandUseTaxWorksheets. Tax Period Rpt. Code Please Do Not Write In This Space Form 10 Nebraska ID Number Due Date: Name and Location Address Name and Mailing Address · Name,address,orownershipchanges?Seeinstructions. Checkthisboxifyourbusinesshaspermanentlyclosed,hasbeensoldtosomeoneelse,oryourpermitisnolongerneeded. New owners must apply for their own sales tax permit. 1 Gross sales and services (see instructions) ....................................................................................... 2 Net taxable sales (see instructions) .................................................................................................... 3 Nebraska sales tax (line 2 multiplied by .055) .................................................................................... 4 Nebraska use tax (see instructions) ............................................................. 4 5 Local use tax from line 1, Nebraska Schedule I ........................................... 5 6 Local sales tax from line 2, Nebraska Schedule I............................................................................... 7 Total Nebraska and local sales tax (line 3 plus line 6) ........................................................................ 8 Sales tax collection fee (line 7 multiplied by .025; if the result is $75.00 or more, enter $75.00) ........ 9 Sales tax due (line 7 minus line 8) ..................................................................................................... Complete Nebraska Schedule I prior to completing lines 5 & 6. 1 2 3 00 00 6 7 8 9 10 Total Nebraska and local use tax (line 4 plus line 5)........................................................................... 10 11Total Nebraska and local sales and use tax due (line 9 plus line 10) ................................................... 11 12 Previous balance with applicable interest at % per year and payments received through 12 Check this box if your payment is being made electronically. 13 Balance due (line 11 plus or minus line 12). Pay in full with return ..................................................... 13 sign here Under penalties of law, I declare that as taxpayer or preparer I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is correct and complete. paid preparer's use only Preparer's Signature Authorized Signature Title Date Daytime Phone Preparer's PTIN EIN Date Email Address Print Firm's Name (or yours if self-employed), Address, and Zip Code Daytime Phone For tax assistance, call 800-742-7474 (NE and IA) or 402-471-5729. This return is due on or before the 20th day of the month following the tax period indicated above. Paper filers mail this return and payment to: Nebraska Department of Revenue, PO Box 98923, Lincoln, NE 68509-8923. 6-002-1967 Rev. 10-2014 Supersedes 6-002-1967 Rev. 10-2011 American LegalNet, Inc. www.FormsWorkFlow.com Nebraska Schedule I -- Local Sales and Use Tax City Code Rate Use Tax Sales Tax County Code Rate Use Tax Sales Tax 1 Total of amounts entered in the use tax column (enter here and on line 5, Form 10) ................................................................................... 1 2 2 Total of amounts entered in the sales tax column (enter here and on line 6, Form 10) .............. To be completed by retailers who are leasing (1) motor vehicles to others for periods of more than 31 days; (2) ATVs or UTVs; or (3) motorboats or motorized personal watercraft. Nebraska Schedule I --MVL,ATV,UTV,andMotorboatLeasesorRentals 1 Enter the amount of state sales tax included on Form 10, line 3, that was reported on long-term leases (more than 31 days) of motor vehicles (see instructions) ........................................ (Code 600-600) 2 Enter the amount of state sales tax included on Form 10, line 3, that was reported on all leases or rentals of all-terrain and utility-type vehicles (see instructions) .......................................... (Code 626-626) 3 Enter the amount of state sales tax included on Form 10, line 3, that was reported on all leases or rentals of motorboats and motorized personal watercraft (see instructions)....................... (Code 633-633) American LegalNet, Inc. www.FormsWorkFlow.com  Nebraska Net Taxable Sales and Use Tax Worksheets · Theonlineversionoftheseworksheetsexpandsfordetailedinformation. · Toseethisinformation,completetheseworksheetsonline. Form 10 Worksheets Nebraska Net Taxable Sales Worksheet 1. Gross Sales and Services in Nebraska Regulation 1-007. Enter on line 1, Form 10 ..... Allowable Exemptions and Deductions From Gross Sales A. Sales of nontaxable services. See taxable services in Regulation 1-007 ............................. B. Sales of items or taxable services sold for resale. Regulation 1-013 .................................... C. Sales to exempt purchasers. Regulation 1-012 ..................................................................... D. Sales of exempt items or services. Regulation 1-012 ............................................................ E. Exempt sellers. Regulation 1-012 .......................................................................................... F. Use-based exemptions. Regulation 1-012 ............................................................................. G. Other allowable deductions (see our website for a list of allowable deductions and the applicable regulations). ............................................................................................. H. Total allowable exemptions and deductions (A through G) .................................................... 2. Net Taxable Sales (line 1 minus line H). Enter on line 2, Form 10 ................................. Nebraska Use Tax Worksheet 1. Cost of items and taxable services purchased for use in Nebraska on which tax was not paid. Regulation 1-002 ................................................................................................. 2. Cost of items withdrawn from inventory for personal or business use. Regulation 1-002 .................. 3. Total amount subject to Nebraska use tax (line 1 plus line 2).......................................................... 4. Nebraskausetax(line3multipliedbytherateidentifiedonline3,Form10) ................................. 5. Credit for tax paid