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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)) ................................................................................................................................................................................................................
      A1  STATE EXCESS TAX COLLECT ...............................................................................................................................................................................................................................................
      A2  EXCESS TAX ACCOUNTING CREDIT  .....................................................................................................................................................................................................................................
      A3  SUBTOTAL (LINE AA + A1 – A2 = NET/AZ COUNTY TAX) .....................................................................................................................................................................................................
  BB  NET CITY TAX (PAGE 2, LINE 14, COLUMN (M)) ...........................................................................................................................................................................................................................
      B1  CITY EXCESS TAX COLLECTED .............................................................................................................................................................................................................................................
      B2  SUBTOTAL (LINE BB + B1 = NET CITY TAX) ..........................................................................................................................................................................................................................
  CC  NET TAX DUE ON THIS RETURN (LINE A3 + LINE B2 = LINE CC) ..............................................................................................................................................................................................
  DD  TPT ESTIMATED PAYMENTS TO BE USED ON THIS RETURN (JUNE RETURN ONLY, DUE IN JULY) ....................................................................................................................................
  EE  TAX DUE NET OF TPT ESTIMATED PAYMENTS (LINE CC - LINE DD = LINE EE) ......................................................................................................................................................................
  FF  TOTAL AMOUNT REMITTED WITH THIS RETURN........................................................................................................................................................................................................................              $
 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) ....................................

   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) .................................................................................................
                    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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