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TRANSACTION PRIVILEGE, USE, AND SEVERANCE TAX RETURN - (TPT-EZ)                                                           Calculate        Reset
Arizona Department of Revenue                                              Form TPT-EZ is for filing 
PO Box 29010 - Phoenix, AZ  85038-9010                                                               TPT-EZ return is due the 20th day of the month following 
For assistance out of state or in the Phoenix area:  (602) 255-3381 or     periods beginning on or   the month in which the transactions were conducted
Statewide, toll free area codes 520 and 928:  (800) 352-4090               after June 1, 2016.
                                                                                                     TAXPAYER IDENTIFICATION NUMBER                                                                                                                                              SSN   EIN
 
                                                                                                     LICENSE NUMBER
TAXPAYER INFORMATION                                                                                 PERIOD BEGINNING                      PERIOD ENDING
 AMENDED RETURN           FINAL RETURN          CHECK HERE AND SIGN BELOW IF YOU
                            (Cancel License)          HAVE NO GROSS RECEIPTS TO REPORT               M                    M D D Y Y Y Y    M                                                                                                                                  M D D Y Y Y Y
 BUSINESS NAME                                                                                       REVENUE USE ONLY. DO NOT MARK IN THIS AREA
                                                                                                       REMINDER ABOUT PRINTING: 
 C/O
                                                                                                     * Use the Blue PRINT buttons to print your completed 
                                                                                                     return with calculations. 
 MAILING ADDRESS                                                                                     * Do NOT use the print icon on the menu bar. 
                                                                                                       RESET BUTTON: 
 CITY                                          STATE       ZIP CODE                                  * Use reset button to reset ALL fields. 
                                                                                                     POSTMARK DATE  CALCULATE BUTTON:                                                                                                                                        RECEIVED DATE
 ADDRESS CHANGED (MAILING ADDRESS ONLY)              BUSINESS PHONE NUMBER                          * Yellow fields will auto-calculate, if not click Calculate 
                                                                                                     button.  

  AA NET AZ/COUNTY TAX (PAGE 2, LINE 7, COLUMN (M)) .......................................................................................................................................................................................................... AA                           0.00
      A1  STATE EXCESS TAX COLLECT ......................................................................................................................................................................................................................................... A1
      A2  EXCESS TAX ACCOUNTING CREDIT  ...............................................................................................................................................................................................................................     A2
      A3  SUBTOTAL (LINE AA + A1 – A2 = NET/AZ COUNTY TAX) ...............................................................................................................................................................................................                   A3
  BB  NET CITY TAX (PAGE 2, LINE 14, COLUMN (M)) .....................................................................................................................................................................................................................       BB             0.00
      B1  CITY EXCESS TAX COLLECTED ....................................................................................................................................................................................................................................... B1
      B2  SUBTOTAL (LINE BB + B1 = NET CITY TAX) ....................................................................................................................................................................................................................        B2
  CC  NET TAX DUE ON THIS RETURN (LINE A3 + LINE B2 = LINE CC) ........................................................................................................................................................................................                     CC
  DD  TPT ESTIMATED PAYMENTS TO BE USED ON THIS RETURN (JUNE RETURN ONLY, DUE IN JULY) ..............................................................................................................................                                                        DD
  EE  TAX DUE NET OF TPT ESTIMATED PAYMENTS (LINE CC - LINE DD = LINE EE) ................................................................................................................................................................                                   EE
  FF  TOTAL AMOUNT REMITTED WITH THIS RETURN.................................................................................................................................................................................................................. FF              $
 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.
                                                                                      The taxpayer designates the individual listed below as the person to contact to schedule an audit of 
                                                                                       this return and authorizes the disclosure of confidential information to this individual.
                                                       
 TAXPAYER PRINTED NAME
                                                                                                                                            
                                                                                       PAID PREPARER’S  PRINTED NAME (OTHER THAN TAXPAYER)  PAID PREPARER’S TIN 
                                                                           
 TAXPAYER SIGNATURE                                        DATE

 TAXPAYER PHONE NO.           TITLE                                                    PAID PREPARER’S SIGNATURE (OTHER THAN TAXPAYER)  PAID PREPARER’S PHONE 
                                                 PLEASE MAKE CHECK PAYABLE TO: ARIZONA DEPARTMENT OF REVENUE
ADOR 11263 (7/16)                                                                                                                                                                                                                                                                          

 TRANSACTION PRIVILEGE, USE, AND SEVERANCE TAX RETURN - (TPT-EZ)                                                                                     LICENSE NUMBER:                                                         Page 2

   STATE (AZ) /COUNTY TRANSACTION DETAIL         (See Table 1 on the Tax Rate Table, www.azdor.gov)
   (A)  (B)          (C)         (D)   (E)                               (F)                                                  (G)              (H)           (I)                    (J)      (K)            (L)              (M)
                                                                                                                   DEDUCTIONS                                AZ /                            ACCTNG     (H) X (K) = (L)     (J) - (L) = (M)
        REG.        NAME OF      BUS.  DESC. OF                         GROSS                                                 FROM       (F) - (G) = (H)     COUNTY      (H) X (I) = (J)     CREDIT   ACCOUNTING            AZ/COUNTY  
        CODE        REGION     CODE BUS. ACTIVITY                       RECEIPTS                                   SCHEDULE A            NET TAXABLE      TAX RATE       TOTAL TAX           RATE           CREDIT          TAX DUE
 1
 2
 3
 4
 5
 6
 7 AZ/COUNTY SUBTOTAL  (AMOUNT IN COLUMN M, 
   MUST EQUAL PAGE 1, LINE AA) ....................................                                                                                                                                                                 0.00

   CITY TRANSACTION DETAIL       (See Table 2 on the Tax Rate Table, www.azdor.gov)
   (A)   (B)               (C)         (D)                          (E)                                        (F)                 (G)                   (H)             (I)             (J)            (K) (L)              (M)
                                                                                                                                   DEDUCTIONS                          CITY                                              (J) - (L) = (M)
   LOC.  CITY                          BUS.      DESC. OF                                                                          FROM              (F) - (G) = (H)    TAX             (H) X (I) = (J)     CITY             CITY
   CODE CODE            NAME OF CITY   CODE BUS. ACTIVITY                                                     GROSS RECEIPTS       SCHEDULE A        NET TAXABLE       RATE             TOTAL TAX           CREDIT           TAX DUE
 8
 9
 10
 11
 12
 13
 14 CITY SUBTOTAL  (AMOUNT IN COLUMN M, MUST EQUAL PAGE 1, 
   LINE BB) .................................................................................................                                                                                                                       0.00

                    NOTE: The deduction amounts that have been listed on the lines in column G must be itemized by category for each region code and business code reported.
                         The total of the amounts listed in Schedule A must equal the total of the Deduction Amounts listed in column G.

   SCHEDULE A - DEDUCTION DETAIL INFORMATION                                                                                                   SCHEDULE A - DEDUCTION DETAIL INFORMATION
   STATE (AZ) /COUNTY DEDUCTIONS DETAIL                                                                                                        CITY DEDUCTIONS DETAIL 
   (A)   (B)        (C)      (D)            (E)                                                               (F)                              (A)   (B)     (C)     (D)                 (E)                            (F) 
                                                                                                                                                                                                                         
        REGION   BUS.  DEDUCTION                                                                              DESCRIPTION OF                   LOC.  CITY BUS.  DEDUCTION                                   DESCRIPTION OF  
        CODE        CODE CODE         DEDUCTION AMOUNT                                                        DEDUCTION CODE                   CODE  CODE CODE       CODE            DEDUCTION AMOUNT       DEDUCTION CODE
 1                                   $                                                                                                   8                                          $
 2                                   $                                                                                                   9                                          $
 3                                   $                                                                                                   10                                         $
 4                                   $                                                                                                   11                                         $
 5                                   $                                                                                                   12                                         $
 6 AZ/COUNTY TOTAL DEDUCTIONS        $                                                                                                   13 CITY TOTAL DEDUCTIONS ................. $
   TOTAL MUST EQUAL TOTAL ON PAGE 2, LINE 7, COLUMN G                                                                                          TOTAL MUST EQUAL TOTAL ON PAGE 2, LINE 14, COLUMN G
 ADOR 11263 (7/16)                                                                                                                                                                                                           
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