ST - Sales, Use, and Gross Receipts Tax (A) Fill in this circle if this is an amended return. (F) Account Number *Required (Ex: 999999 00) Period Ending Due Date of Return M M Fill in this circle if you are no longer in business and enter your last day of business. Form North Dakota Office of State Tax Commissioner WEB / D D / Y Y Y Y *Required (Ex: MM/DD/YYYY) Taxpayer Name Address City, State, ZIP Code Fill in this circle if this business has changed ownership. Provide name, address, and telephone (C) number of new owner: New Owner Name, Address, Phone Number Fill in this circle if your address has changed. Column A Column B 5% Sales & Purchases 1. Total Sales (do not include tax) 2. Total Nontaxable Sales 3. Items Subject to Use Tax 4. Taxable Balance (Add lines 1 and 3, and subtract line 2) 5. State Tax (Multiply line 4 by the ND tax rate) 6. Total State Tax (Add column A and column B on line 5) 7. Compensation Discount - Registered Permit Holders only (Multiply line 6 by .015 ($110.00 maximum) - see instructions) 8. Net State Tax Due (subtract line 7 from line 6) 9. Penalty (See Instructions) 10. Interest (See Instructions) 11. State Tax, Penalty, and Interest (a) (b) LOCAL OPTION SALES, USE, & GROSS RECEIPTS TAXES To report more than ten local option taxes, see Instructions. C A Total Local Option Tax B (Do Not Enter Sales) Local Code City, County, or Tribal Name/Location E Compensation D Allowance Compensation (See Instructions) Rate F Net Local Option Tax Due (Column C Minus Column E) . . . . . . . . . . 12. Net Local Option Tax Due 13. Total Local Option Penalty and Interest (See Instructions) 14. Total Due With Return Make check or money order payable to North Dakota Tax Commissioner I declare that this return has been examined by me and to the best of my knowledge and belief is a true, correct, and complete return. Taxpayer Signature Date Title Please Do Not Write In This Space Contact Person (Please Print or Type) Contact Phone Number Mail to: Office of State Tax Commissioner, PO Box 5623, Bismarck, ND 58506-5623 Taxpayer Copy American LegalNet, Inc. www.FormsWorkFlow.com Form ST - Sales, Use, and Gross Receipts Tax Return instructions General instructions return for each reporting period even if no sales were made or no tax is due. Form ST Do's and Don'ts Line 1 Line 2 Line 3 Do A preprinted return, instructions, and return reporting period to every registered permit www.nd.gov/tax Line 4 Don't Line 5 Line 6 All returns are due the last day of the month following the reporting period. Line 7 ­ All registered permit holders For best results, complete the original customized form and mail it in the return envelope provided. Effective with the July 1, 2013 return, the compensation may not exceed $110.00 per return. If you use an approved software package to prepare your return it is essential to enter the following identifying information properly: ensure the proper vendor compensation Line 8 Line 9 Account number. Enter the account Period ending. Name and Address. Line instructions - State and Tribal Taxes Standing Rock Sioux Tribe all transactions in the same manner as a city XXXs, calculate penalty on the total state column, enter the penalty amounts in items Line 10 American LegalNet, Inc. www.FormsWorkFlow.com Line 11 Local option sales, use, and gross receipts taxes Column F--Net local option tax due compensation rates are preprinted on the www. nd.gov/tax Line 12--Net local option tax due Line 13--Local option penalty and interest Column C--Total local option tax Schedule ST-Local lists the Line 14--Total due with return Instructions for reporting local option taxes: Make your check payable to North Column E--Compensation allowance Dakota Tax Commissioner. Note: If amount in column C is negative, enter zero in column E. PO Box 5623 Bismarck, ND 58506-5623 Phone: 701.328.1246 www.nd.gov/tax Local Option Taxes: Code/Jurisdiction Name/Compensation Rate/Tax Rate ½ ½ ½ ¾ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ½ ¾ ½ ¼ ¼ ¼ ½ ½ 0 1 2 3 4 5 6 Phone: 701.328.1246, www.nd.gov/tax 21997 (Instructions revised 1/17) American LegalNet, Inc. www.FormsWorkFlow.com