TRANSACTION PRIVILEGE (SALES) AND USE TAX RETURN
                                                                                                            License Number

                     City of Chandler
                     Mail Stop 701                                                                          Period Ending
                     PO Box 15001
                     Chandler, AZ 85244-5001

                                                                                                        Delinquent If Not Received By

                                                                                                        Check here if mailing
                                                                                                        address has changed.
                                                                                                        Please make corrections to
                                                                                                        the preprinted address.
                                                                                                        Location Address:

Place a check here and sign at the                                                                          THIS RETURN IS DUE ON
bottom if you have no activity to report.                                                                   THE 20TH OF THE MONTH
Complete Both Sides of Form                   Column 1                             Column 2             Column 3      Col. 4                                Column 5
                          Business
                          Class                                                    From Sch. A, on back                x Tax
  Line  Business Activity Code              Gross Receipts / Use Taxable Purchases -  Deductions        = Net Taxable  Rate                                 = Tax Amount
1      USE TAX                      99      ,      ,       .                                                          .0151.5%                              0.00

2
                                            ,      ,       .                                                                                                0.00
3
                                            ,      ,       .                                                                                                0.00
4
                                            ,      ,       .                                                                                                0.00
5       TOTAL FROM ADD'L PAGES
                                            ,      ,       .
6
             SUBTOTALS                      ,      ,       .
7                    ENTER EXCESS CITY TAX COLLECTED (From SCHEDULE C on the back)                      Plus (+)

8                                                  TOTAL TAX DUE (Add lines 6 plus 7)                   Equals (=)

9                                           PENALTY & INTEREST (See instructions on back)               Plus (+)

10                                            ENTER TOTAL LIABILITY (Add lines 8 plus 9)                Equals (=)

11                        ENTER CREDIT BALANCE TO BE APPLIED (From Schedule B, on back)                 Minus (-)

12                                     ENTER NET AMOUNT DUE (Subtract line 11 from line 10)             Equals (=)

13                                                                                 ENTER TOTAL AMOUNT PAID

       Under penalties of perjury, I declare that I have examined this return, including the accompanying schedules and statements, and to the best of my knowledge and belief it is true,
                          correct and complete.  The declaration of the paid preparer is based upon all information of which the preparer has any knowledge.

Taxpayer's Signature                          Date                                 Paid Preparer's Signature

Printed Name                                  Phone Number                         Printed Paid Preparer's Name
                                    A SIGNATURE IS REQUIRED TO MAKE THIS RETURN VALID
                                            Return original with remittance in envelope provided.
                     Please make check payable to: CITY OF CHANDLER and list your license number on your check.
                                                                                                                       4615125699

     License No.                                      Report Period:                                                                           9412125699
DUE DATE:  City privilege tax returns are due on the 20th of the month following the reporting period.  A return must be submitted even if no taxes are due.  A return is considered
delinquent if not received by the last business day of the month.  A business day is any day except Saturday, Sunday or a legal City holiday.
Postmarks are not evidence of timely filing.
PENALTIES:
1. Failure to File - A penalty of 5% of the tax due will be assessed for each month, or fraction thereof, elapsing between the delinquency date of the return and the date received.
2. Failure to Pay - A penalty of 10% of any unpaid tax will be assessed if the tax due is not paid on or before the delinquency date.
3. Total Penalty - Combined Failure to File and Failure to Pay penalties assessed will not exceed 25%.
INTEREST: Taxes unpaid after the delinquency date are assessed interest that cannot be waived.  Beginning 10/01/05, the interest rate is the rate in effect for the Arizona Depart-
ment of Revenue, and outstanding interest is compounded annually on January 1.
SCHEDULE A - DETAILS OF DEDUCTIONS:          All deductions and exemptions used in computing City transaction privilege tax must be entered below.  Detailed records supporting all
deductions and exemptions claimed must be maintained. Failure to maintain supporting records may result in the disallowance of claimed amounts.
Please note: Not all deductions are available for all business classifications.
SCHEDULE B - Credit Details: List credits to be used with this return. Documentation must be attached.
SCHEDULE C - Excess Tax Collected: List the excess tax collected by taxable activity.
NOTE:  The line numbers at the top of each column below correspond with the line numbers listed on the front page.

                                              Line 2                                                  Line 3                                   Line 4
SCHEDULE A                         Ded.       Business Class Code                      Business Class Code                                     Business Class Code
Deduction Description              Code                                                                                                         
Discounts and Refunds              52       , ,                                .     ,                ,           .                          ,  ,    .
Sales for Resale                   54       , ,                                .     ,                ,           .                          ,  ,    .
Out-of-State Sales                 55       , ,                                .     ,                ,           .                          ,  ,    .
Prescriptions / Prosthetics        58       , ,                                .     ,                ,           .                          ,  ,    .
Gasoline & Use Fuel                59       , ,                                .     ,                ,           .                          ,  ,    .
Retail Service Labor               63       , ,                                .     ,                ,           .                          ,  ,    .
Tax Collected or Factored          64       , ,                                .     ,                ,           .                          ,  ,    .
Qualifying Healthcare Sales        65       , ,                                .     ,                ,           .                          ,  ,    .
Interstate Telecommunications      66       , ,                                .     ,                ,           .                          ,  ,    .
Exempt Capital Equipment           73       , ,                                .     ,                ,           .                          ,  ,    .
Freight-Out / Delivery             74       , ,                                .     ,                ,           .                          ,  ,    .
Food Stamps / WIC                  79       , ,                                .     ,                ,           .                          ,  ,    .
Bad debts on which tax was paid    81       , ,                                .     ,                ,           .                          ,  ,    .
Trade-In Allowances                82       , ,                                .     ,                ,           .                          ,  ,    .
Other (explain)_____________       75       , ,                                .     ,                ,           .                          ,  ,    .
Other (explain)_____________       75       , ,                                .     ,                ,           .                          ,  ,    .
SALES TO U.S. GOVERNMENT
50% of Retail                      56       , ,                                .     ,                ,           .                          ,  ,    .
100% of Manufacturing              57       , ,                                .     ,                ,           .                          ,  ,    .
CONSTRUCTION CONTRACTING
35% Standard Contracting           70       , ,                                .     ,                ,           .                          ,  ,    .
Subcontracting Income              71       , ,                                .     ,                ,           .                          ,  ,    .
Out-Of-City Contracting            62       , ,                                .     ,                ,           .                          ,  ,    .
Total Deductions (copy totals to front)     , ,                                .     ,                ,           .                          ,  ,    .
SCHEDULE B  Credit Details (must attach documentation)
1. Accounts Receivable Credit      B        , ,                                .
2. Speculative Builder Credit               , ,                                .
(For Taxes Paid By The Contractor) B                                                 Total Schedule B (copy total to front, line 11)
SCHEDULE C Excess Tax Collected
Excess Tax by taxable activity     C          ,                                .                      ,           .                             ,    .
                                                                                     Total Schedule C (copy total to front, line 7)

                   FOR ASSISTANCE, CALL:  City of Chandler (480) 782-2280   Fax: (480) 782-2343 or visit our website: chandleraz.gov