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Form                                                                                                                   Tax Account Number
         UT-5
Wisconsin Department
     of Revenue                                 Consumer Use Tax Return                                                Period Begin Date (MM DD YYYY)
Use BLACK INK Only             Tab to navigate throughout form.
Name                                                                                                                   Period End Date (MM DD YYYY)

Address    (number and street)                                                                                         Social Security Number

City                                                           State      Zip Code                                     Federal Employer Identification No.

Part A        Computation of Use Tax
                                                                                                                          Tax                Tax
For line 2 purchases - Fill in Part B information below.                                          Purchases            Rate      (Purchases x Tax Rate)
    1Purchases subject to 5% state use tax  ..............           1a                                                x  .05  = 1b
    2Purchases subject to 0.5% county use tax (from line 11)         2a                                                x  .005 = 2b
    Purchases3    prior to April 1, 2020     subject to 0.1% baseball
     stadium tax. This tax ended 3-31-20 ................            3a                                                x  .001 = 3b
    Purchases4    prior to October 1, 2015     subject to 0.5%
     football stadium tax. This tax ended 9-30-15   .........        4a                                                x  .005 = 4b
    5Total use tax (add lines 1b, 2b, 3b, and 4b)   ............................................                                 5
    6Credit for state and/or local sales or use tax paid to another state on purchases included on
     lines 1a-4a.  See line 6 instructions on next page  .......................................                                 6
    7Net use tax (line 5 minus line 6)  .....................................................                                    7
    8Interest and penalty (see instructions on the back of the return)  ............................                             8
   9 Total Amount Due (add lines 7 and 8)   ...............................................                                      9

Part B        County Information for Purchases Subject to County Use Tax
                                                                 10Enter the county name, code and purchases which are subject to that 
                                                                   county’s 0.5% county use tax.
                         NOTE
     To report county use tax for more than                               County Name                            County
         6 counties, leave lines 10a-10f blank,                                                (first 5 letters) Code            Purchases
     and complete and enclose Schedule CT.                          10a
     To obtain a Sch. CT, call (608) 266-2776
                or go to revenue.wi.gov                             10b

                                                                    10c
Mail to:
                                                                    10d
     Wisconsin Department of Revenue
     PO Box 8946                                                    10e
     Madison WI  53708-8946
                                                                    10f
                                                                11 Total County Purchases   .  11
                                                                   • Add lines 10a through 10f
                                                                   • Enter line 11 total on line 2a

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 Name   (please print clearly)          Signature                                                        Phone Number                Date
                                                               Remember to sign your 
                                                                   return after printing.
SU-050 (R. 4-20)