TPT-1 return is due the 20th day of the month following the reporting period. TRANSACTION PRIVILEGE, USE, AND SEVERANCE TAX RETURN (TPT-1) STATE LICENSE NUMBER: Arizona Department of Revenue PO BOX 29010 • PHOENIX, AZ 85038-9010 For assistance out-of-state or in the Phoenix area: (602) 255-2060 or Statewide, toll free from area codes 520 and 928: (800) 843-7196 TAXPAYER IDENTIFICATION NUMBER: EIN SSN PERIOD BEGINNING: I. TAXPAYER INFORMATION Amended Return Multipage Return One-Time Only Return Final Return: PERIOD ENDING: M M D D Y Y Y Y DOR USE ONLY M M D D Y Y Y Y LABELED RETURN (CANCEL LICENSE) BUSINESS NAME C/O POSTMARK DATE ADDRESS CITY STATE ZIP RECEIVED DATE Address Changed LINE II. TRANSACTION DETAIL (If more reporting lines are necessary, please attach continuation pages.) (A) BUSINESS DESCRIPTION (B) (C) REGION BUSINESS CODE CLASS (D) (E) (F) (G) (H) GROSS AMOUNT DEDUCTION AMOUNT NET TAXABLE AMOUNT TAX RATE TOTAL TAX AMOUNT (I) ACCOUNTING CREDIT RATE (J) = (F × I) ACCOUNTING CREDIT 1 2 3 4 5 Subtotal ....................................... III. TAX COMPUTATION 1 Total deductions from Schedule A ............................................................... 1 2 Total Tax Amount (from column H) .............................................................. 2 3 State excess tax collected ........................................................................... + 3 4 Other excess tax collected .......................................................................... + 4 5 Total Tax Liability: Add lines 2, 3, and 4...................................................... = 5 6 Accounting Credit (from column J) .............................................................. 6 7 State excess tax accounting credit: Multiply line 3 by .01 .......................... + 7 8 Total Accounting Credit: Add lines 6 and 7 ................................................. = 8 9 Net tax due line: Subtract line 8 from line 5 ................................................ 9 10 Penalty and interest ..................................................................................... + 10 11 TPT estimated payments to be used ........................................................... - 11 AMENDED RETURN ONLY ORIGINAL REMITTED AMOUNT 12 Total amount due this period ....................................................................... = 12 13 Additional payment to be applied (for other periods) ................................... + 13 $ DOR USE 14 TOTAL AMOUNT REMITTED WITH THIS RETURN .................................. = 14 $ 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. ► PAID PREPARER’S SIGNATURE (OTHER THAN TAXPAYER) ► TAXPAYER’S SIGNATURE ADOR 10872 (6/10) Previous ADOR 60-1046 DATE PAID PREPARER’S EIN OR SSN Please make check payable to Arizona Department of Revenue. American LegalNet, Inc. www.FormsWorkFlow.com Transaction Privilege, Use, and Severance Tax Return (TPT-1) LICENSE NO. ______________________ Schedule A: Deduction Detail Information DEDUCTION CODES The deduction amounts that have been listed on the lines in Section II, Column E must be itemized by category for each Region Code and Business Class reported. The total of the amounts listed in Schedule A must equal the total of the Deduction Amounts listed on page 1. (See page 4 of the TPT-1 Instructions.) Deduction Codes for itemizing deductions, with a paraphrased description of the deduction (or exemption), are listed at right. Some of the codes may be used for more than one business classification. Several additional Deduction Codes, as well as the statutory wording and any administrative guidance for each deduction code, are provided on the Department’s web site. The actual text of the statutory deduction, exemption or exclusion is controlling for amounts taken as deductions on Form TPT-1. If a valid state statutory deduction (or Model City Tax Code deduction provision) exists but is not shown in the listed Deduction Codes, use Deduction Code 999 for a state deduction, and use Code 888 for a city deduction. For a listing of all Deduction Codes, the relevant statutory text and any administrative guidance, please go to www.azdor.gov/Forms/TPT.aspx and click on “TPT-1 Deduction Codes.” 503 TAX collected or factored ......................................................................................................................... 551 OTHER STATE deductions (use when specific deduction is not listed below)................................................ 999 OTHER CITY deductions (use when specific deduction is not listed below) .................................................. 888 DEDUCTIONS FOR SELLERS: (Purchasers are not allowed to claim TPT deductions) AIRCRAFT, navigational and communication instruments sold to commercial airlines or foreign governments . 508 BAD DEBT deduction ............................................................................................................................... 558 CHEMICALS: SALES of chemicals used in certain businesses. See ARS § 42-5061(A)(39) ............................ 510 FOOD for home consumption sold by qualified retailer ............................................................................... 506 FOOD purchased with food stamps from a qualified retailer ........................................................................ 513 FOOD items sold to a prison, jail, or other institution under control of DOC, DPS, or Sheriff’s office ............... 514 FOOD sales to a school district or charter school by a RESTAURANT ........................................................... 562 FUEL: A retailer’s SALES of vehicle fuel and aviation fuel See ARS § 42-5061(A)(22) .................................. 515 FUEL: SALES of alternative fuels used to propel a motor vehicle ................................................................ 509 INTERNET ACCESS: SALES of Internet access by a telecommunications business........................................ 517 INTERSTATE COMMERCE: Sales made in interstate commerce................................................................... 504 JOB PRINTING: Actual postage and freight expenses separately stated on invoices ..................................... 561 LIVESTOCK AND POULTRY: Sales of feed, salts, vitamins, and other additives to business ........................... 520 LIVESTOCK AND POULTRY: Sales of growth promotant implants/injectable medicines to business ................ 516 LIQUEFIED NATURAL GAS used to fuel compressor equipment ................................................................... 563 521 MACHINERY AND EQUIPMENT (M&E) — SALES of: Deduction Detail (L) (M) BUSINESS DEDUCTION CLASS CODE CODE LOTTERY TICKETS: A retailer’s SALES of lottery tickets ............................................................................. SCHEDULE A (K) REGION CODE GENERAL DEDUCTIONS FOR SELLERS: RESALE: Sales for resale ......................................................................................................................... M&E used directly in manufacturing, processing, fabricating, printing, refining, or metallurgical operations . (N) DEDUCTION AMOUNT 522 M&E used directly in mining operations .................................................................................................. 523 M&E or transmission lines used directly in producing or transmitting electrical power ................................ 524 M&E, technology, or related supplies sold to qualified persons (See ARS § 42-5061 exemptions.) ............... 525 M&E used in research and development ................................................................................................. 553 MEDICAL EQUIPMENT, including eyeglasses, hearing aides, DME, prosthetic appliances ............................... 526 MEMBERSHIPS (Class 12 only): Health, fitness, or private recreational establishments; Monthly or longer .... 527 MOTION PICTURE PRODUCTION COMPANY exemptions (deductions) ......................................................... 559 MOTOR VEHICLE (MV): MV and parts sold to a motor carrier subject to the Title 28 motor carrier fee who leases the vehicle ......... 528 MV sold at auction to a nonresident if seller delivers or ships out of state ................................................. 529 MV sold to a qualified Native American................................................................................................... 530 MV sold to a qualifying nonresident (See ARS § 42-5061 exemptions.) ..................................................... 531 MV: Manufacturer’s cash rebate assigned by purchaser to dealer ............................................................ 501 MV LEASE: First month’s lease payment transferred to third party leasing company ................................. 556 PIPES OR VALVES, 4” diameter or larger to transport oil, natural/artificial gas, water, coal slurry ................... 535 PRESCRIPTION DRUGS or prescribed medical oxygen including equipment ................................................. 536 PRIME CONTRACTING (PC): PC: 35% reduction (= Gross Receipts – Statutory Deductions × 35%) .................................................. 502 PC: Land deduction (fair market value) ................................................................................................. 518 PC: Subcontracting income................................................................................................................... 550 PC: Income derived from direct costs of providing architectural / engineering services ............................. 557 PC: Development or impact fees paid to state or local government ......................................................... 560 SEEDS and other propagative material sold to COMMERCIAL AGRICULTURE businesses ............................... 537 SERVICES provided in connection with retail sales ..................................................................................... 549 SOLAR ENERGY DEVICES sold by a registered solar retailer or prime contractor........................................... 538 TEXTBOOKS that are required by a state university or community college ................................................... 505 TANGIBLE PERSONAL PROPERTY (TPP): TPP shipped or delivered directly to a destination outside the U.S. for use in that foreign country .............. 540 TPP sold to a nonresident and shipped or delivered out-of-state by the seller for use outside of Arizona ..... 541 TPP sold to a taxable PRIME CONTRACTOR or sub to be physically incorporated into a project or structure. 552 TPP sold or rented to an IRS 501(C)(3) ORGANIZATION that feeds the needy and indigent for free ........... 544 TPP sold or rented to a QUALIFYING HEALTH CARE ORGANIZATION to be used for specified purposes ...... 545 TPP sold or rented to a QUALIFYING HOSPITAL...................................................................................... 546 U.S. GOVT: Retail sales to manufacturer, modifier, assembler or repairer if end product sold to U.S. GOVT.... 543 U.S. GOVT: Retail sales to U.S. GOVT by a manufacturer, modifier, assembler or repairer (100% deduction) . 547 U.S. GOVT: Other RETAIL sales directly to U.S. GOVT (TPT: 50% deduction; USE TAX: 100% deduction) .... Total Deductions........ ADOR 10872 (6/10) Previous ADOR 60-1046 548 WARRANTIES or service contracts ............................................................................................................ 542 American LegalNet, Inc. www.FormsWorkFlow.com Transaction Privilege, Use, and Severance Tax Return (TPT-1) LICENSE NO. ______________________ LINE TRANSACTION DETAIL (ADDITIONAL TRANSACTIONS) (A) BUSINESS DESCRIPTION (B) (C) REGION BUSINESS CODE CLASS (D) (E) (F) (G) (H) GROSS AMOUNT DEDUCTION AMOUNT NET TAXABLE AMOUNT TAX RATE TOTAL TAX AMOUNT (I) ACCOUNTING CREDIT RATE (J) = (F × I) ACCOUNTING CREDIT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Subtotal .................................... ADOR 10872 (6/10) Previous ADOR 60-1046 American LegalNet, Inc. www.FormsWorkFlow.com