Nevada Department of Taxation 
Nevada Commerce Tax Return 
Tax ID No                                                                                                             or NVBID   N     V
Business Entity NAICS code category                                                         Choose:                                             For the taxable year   through 
Business Entity legal name 
Business Entity address
                                                                    If Nevada gross revenue of your business is $4,000,000 or less during the 2018-2019DO NOT           filetax yearthisand.return thereafter, 
                                                                    If Nevada gross revenue of your business exceeds $4,000,000 during the tax year, you are REQUIRED to file this return.

                                                                    Business closed                Amended return                      Alternative situsing method     Estimates used 
                                                                    Gross Revenue from engaging in business in Nevada 
                                                                       1  Sale of inventory                                                                          1 
                                                                       2  Service performance                                                                        2 
                                                                       3  Rents, royalties and leases                                                                3 
                                                                       4  Interest income from credit sales and loans                                                4 
                                                                       5  Damages received from litigation for loss of business income                               5 
                                                                       6  Insurance proceeds for loss of business income                                             6 
                                  Sitused to Nevada                    7  Forgiven debt                                                                              7 
                                                                       8  Other revenue                                                                              8 
                                                                       9  Total Gross Revenue (Line 1 through Line 8)                                                9 
                                                                       10  Less $4,000,000 Threshold                                                         10                           (4,000,000.00)
                                                                       11  Adjusted Gross Revenue (Line 9 less Line 10)                                      11 

                                                                    General Business Deductions 
                                                                       12  Returns and refunds to customers                                                  12 
                                                                       13  Bad debt                                                                          13 
                                                                       14  Distributions required by fiduciary duty or law                                   14 
                                                                       15  Distributions under certain written contracts                                     15 
                                                                       16  Reimbursement of certain expenses and advances from clients                       16 
                                                                                                 rd
                                                                       17  Taxes collected from 3  party and remitted to taxing authority                    17 
                                                                       18  Other deductions                                                                  18 
                                                                    Industry Specific Deductions 
                                                                       19 Employee leasing deduction                                                         19 
                                                                       20 Gaming deduction                                                                   20 
                                                                       21 Health care provider deduction                                                     21 
                                                                       22 Insurance deduction                                                                22 
                                  To the extent included in revenue    23 Liquor tax deduction                                                               23 
                                                                       24 Mining deduction                                                                   24 
                                                                       25 US Armed Forces housing deduction                                                  25 
                                                                       26 Total Deductions (Line 12 through Line 25)                                         26 
                                                                       27 Nevada Taxable Revenue (Line 11 less Line 26, but not less than $0  )              27 
                                                                       28 Tax rate per NAICS code category                                                   28 
                                                                       29 Commerce Tax due                                                                   29 
                                                                       30 Plus penalty                                                                       30 
                                                                       31 Plus interest                                                                      31 
                                                                       32 Plus liability established by Department                                           32 
                                  Tax liability                        33 Less credit(s) approved by Department                                              33 
                                                                       34 Total amount due and payable (Line 29 through Line 33)                             34 
                                                                       35  Amount remitted with the return                                                   35 
                                                                    Under penalty of perjury, I certify that I have examined this return and to the best of my knowledge and belief it is true, correct 
                                                                    and complete. 
Business Entity authorizedPhone number:                                                                                                                                                                        representative’s signature:
Name and title:                                                                                                                                 Date: 
For Department use only 
                                                                                                                                                                       Print
                                                                                                                           Page 1 of 1                                 EXC-F025 
                                                                                                                                                                       V2018.1