Form Wisconsin Sales and Use Tax Return ST-12 Wisconsin Department of Revenue Tax Account Number State, County and Stadium Sales and Use Tax FEIN / SSN *S16107990* Period Begin Date (MM DD YYYY) Period End Date (MM DD YYYY) Due Date (MM DD YYYY) Attention Use BLACK INK Only Check if business discontinued (enter discontinuation date below) Business Name Legal Name (MM DD YYYY) Check if address or name change (note changes at left) Mailing Address - Street or PO Box City State Zip Code Check if this is an amended return Check if correspondence is included Step A Sales Tax – State 1 Total sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Subtractions from total sales: 2 Sales for which you received exemption certificates . . . . . . . . . . . . . . 2 1 3 Sales of exempt property and services (sales that occurred outside Wisconsin, real property, groceries and highway fuel, etc.) . . . . . . . . 3 4 Sales returns, allowances, and bad debts . . . . . . . . . . . . . . . . . . . . . . 4 5 Other (sales tax included in line 1, etc.) . . . . . . . . . . . . . . . . . . . . . . . . 5 6 Total subtractions (add lines 2 through 5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 Sales subject to state sales tax (subtract line 6 from line 1) . . . . . . . . . . . . . . . . . . . . 7 8 State sales tax (line 7 x .05) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Step B Sales Tax – County and Stadium C To report county sales tax O for more than 4 counties, U leave lines 9-12 blank, N T and complete and enclose Y Schedule CT. To obtain a Sch. CT, call (608) 266-1961 or go to www.revenue.wi.gov 13 County Code County Name (see instructions) (first 5 letters) Sales Subject to County Sales Tax 9a 9b 9c 10a 10b 10c 11a 11b 11c 12a 12b 12c Total sales subject to county sales tax (add lines 9c through 12c OR enter total from Sch CT, Col 1) . . . 13 14 County sales tax (line 13 x .005) . . . . . . . . . . . . . . . . . . . . . . 14 Sales Subject to Stadium Sales Tax S T A D I U M 15 Baseball stadium district taxable sales (Milwaukee, Ozaukee, Racine, Washington & Waukesha counties) 16 Football stadium district taxable sales (Brown County) Step C 15a x .001 = 15b 16a x .005 = 16b Sales Tax Before Discount 17 Total sales tax (add TAX amounts from lines 8, 14, 15b and 16b) . . . . . . . . . . . . . . . 17 S-012i (R. 10-07) American LegalNet, Inc. www.FormsWorkFlow.com Step D Discount and Net Sales Tax 18 Total sales tax (fill in amount from line 17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 19 Discount - Applies only if return is filed and tax is paid by due date { If line 18 is $0 to $10, enter the amount from line 18. If line 18 is $10 to $2,000, enter $10. If line 18 is greater than $2,000, multiply line 18 by .005 and enter the result. } 19 20 Net sales tax (subtract line 19 from line 18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Step E Use Tax – State 21 Purchases subject to state use tax Step F 21a x .05 = 21b Use Tax – County and Stadium County Code C To report county use tax O for more than 4 counties, U leave lines 22-25 blank, N T and complete and enclose Y Schedule CT. To obtain a Sch. CT, call (608) 266-1961 or go to www.revenue.wi.gov 26 County Name (see instructions) (first 5 letters) Purchases Subject to County Use Tax 22a 22b 22c 23a 23b 23c 24a 24b 24c 25a 25b 25c Total purchases subject to county use tax (add lines 22c through 25c OR enter total from Sch CT, Col 2) . . 26 27 S T A D I U M County use tax (line 26 x .005) . . . . . . . . . . . . . . . . . . . . . . . 27 Purchases Subject to Stadium Use Tax 28 Baseball stadium district taxable purchases (Milwaukee, Ozaukee, Racine, Washington & Waukesha counties) 28a x .001 = 28b 29 Football stadium district taxable purchases (Brown County) Step G 29a x .005 = 29b Total Amount Due 30 Total sales and use taxes (add TAX amounts from lines 20, 21b, 27, 28b and 29b) . . . 30 31 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 32 Late filing fee ($20.00) and negligence penalty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 33 Total amount due (add lines 30 through 32) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Step H Signature and Mailing Information I hereby certify that this return, including any accompanying schedules and statements, has been examined by me and to the best of my knowledge and belief is a true, correct, and complete return. Contact Person (please print clearly) Mail to: Wisconsin Department of Revenue PO Box 930389 Milwaukee WI 53293-0389 Phone Number Signature For tax questions, call (608) 266-2776 Date *S26107990* American LegalNet, Inc. www.FormsWorkFlow.com