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                                                   Revenue Collections Operations 
                                                             Licensing Office  
                                                                           
                IMPORTANT 
   
  When completing the tax return, do not forget to complete the following 
  information.  
   
   •  Your City of Mesa Transaction Privilege License number 
    
   •  The reporting period (month, quarter, or year) for which the return 
    applies).  
   
   •  The business name and address for which the license is issued.  
   
  You may not received credit for filing your return or payment of your taxes if 
  the above information is missing or incomplete.  
   
  If you have more that one business location in Mesa and you file a 
  consolidated return, you also must file the Supplement for Consolidated 
  Licenses.  This form is available on-line.   

                                                   55 North Center Street 
                                                             PO Box 1466 
                                                   Mesa Arizona 85211-1466 
                                                   (480) 644-2316 Tel 
                                                   (480) 644-3999 Fax 



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                                      Revenue Collection Operations
                                      Special Licensing Office                                                                                                                          License No. ________________License No. ________________
                                      Location:Location:55 North Center Street                                           Mailing:Mailing:
                                      5555 NorthNorth   CenterCenter    StreetStreet                                     POPO   BoxBox 1635016350                                       ReportingReporting PeriodPeriod ________________________
                                      Mesa,Mesa,Mesa   ArizonaArizonaArizona8520185201   85201                           Mesa,Mesa,   AZAZ 8521185211              63506350‐ ‐
                                      Phone:Phone:(480)644-2316                 (480)(480)   644644 23162316‐ ‐ Fax(480)644-3999Fax:Fax: (480)(480)       644644   39993999‐ ‐          DueDue DateDate ____________________________________
                                      Hours:Hours:     7:007:00 AMAM   6:006:00‐ ‐ PMPM                                                   www.mesaaz.gov/salestaxwww.mesaaz.gov/salestax
                                      Days:Days:     MondayMonday ThursdayThursday ‐  ‐
                                      ClosedClosed   onon FridaysFridays                                                                                                                  CANCELCANCEL LICENSE:LICENSE:   
                                                                                         PleaseP                indicate mailing address change here.lease indicateCheckCheckmailing   herehere andand           addresssignsign   atat      thethechange here. 
BusinessBusiness NameName                                                                                                                                                                 bottombottom      toto cancelcancel youryour   license.license.   
                                                                                                                                                                                          ReasonReason   ________________________________________________________________
AddressAddress                                                                                                                                                                            DateDate   BusinessBusiness ClosedClosed   __________________________________________   

City/State/ZipCity/State/Zip
                            TRANSACTION PRIVILEGE TAX (TPT) AND USE TAX RETURN

  Place a check here and sign at the                                                                                                                                                          THIS RETURN IS DUE ON  THIS RETURN IS DUE ON
  bottom if you    THE THE20T20THH                                                                                                                                                                                        OF OF THE MONTH THE MONTH                               have no taxes to file 

                                                                                                                Column 1                                                       Column 2       Column 3                           Column 4                   Column 5
                                                                                                                                                                   Allowable pg 2                                                        x Tax 
Business Description          Line                   Bus. Class                                                 Gross                                                  - Deductions     = Net Taxable                                    Rate               = Tax Amount
                              1                                                                                                                                                                                                          1.75%
                              2                                                                                                                                                                                                          1.75%
                              3                                                                                                                                                                                                          1.75%
                              4 4                                                                                                                                                                                                        1.75%1.75%
                              5                                                                                                                                                                                                          1.75%
                              6                                                                                                                                                                                                          1.75%
USE TAX                       7                                 20                                                                                                                                                                       1.75%
TOTAL FROM ADDTL PAGES        8                                                                                                                                                                                                          1.75%
                              9       SUBTOTAL                                                                                                                                                                                           1.75%
                              10                                           (Total from Schedule B) EXCESS CITY TAX COLLECTED/JET FUEL                                                                                                Plus     (+)
                              11                                                                                                                                                        TOTAL TAX DUE                                Equals (=)
                              12                                                                                                          (see instructions) PENALTY & INTEREST                                                      Plus     (+)
                              13                                                                                                                                               ENTER TOTAL LIABILITY                                 Equals (=)
                              14                                                                                (Total from Schedule B) CREDIT TO BE APPLIED                                                                             Minus   (-)
                              15                                                                                                                                               ENTER NET AMOUNT DUE                                  Equals (=)
                              16                                                                                                                                   ENTER TOTAL AMOUNT PAID
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.

                 Taxpayer's Signature                                                                                    Date                                                           Paid Preparer's Signature 

                 Print Nam e                                                                                             Phone #                                                        Print Paid Preparer's Nam e
                            A SIGNATURE IS REQUIRED TO MAKE THIS RETURN VALID                                                                                                                                         Mailing Address
                             Return original with remittance in envelope provided.                                                                                                                                    PO Box 16350
                              Please make check payable to: CITY OF MESA                                                                                                                                              Mesa Arizona 85211-6350
                                                     Complete both sides of form.

                                                                                                                                                                                                                                                   (TPT-1) (Rev. 06-2009)



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DUE DATE: The due date for the city privilege tax is the 20th of the month following the reporting 
period.  A return is considered timely if received by the last business day of the month.  A business   License No. _____________
day is any day except  Friday, Saturday, Sunday, or legal city holiday.
                                                                                                        Reporting Period __________
PENALTIES:  1.  Failure to File - A penalty of 5% of the tax due will be assessed for each month, 
or fraction elapsing between the delinquency date of the return and the date on which it is filed.  
Filing your return on time, whether or not you pay the tax due, will avoid the late filing penatly.
2.  Failure to Pay - A penalty of 10% of the unpaid tax will be assessed if the tax is not paid timely.
3.  Total Penalty - Total penalties assessed will not exceed 25%.
INTEREST:  Mesa's interest rate is the same as the State rate and continues to accrue until taxes       POSTMARKS ARE NOT EVIDENCE 
are paid.  Interest rate tables are available on the City's Tax & Licensing website, or you may                    OF TIMELY FILING.
contact our office at the number shown on the form. Interest may not be waived by the Tax 
Collector.
CHECK YOUR RETURN:  Check the amounts recorded by type of income for each line item as follows.
             *   Itemized deductions equal the total deductions recorded.
             *   Taxable income equals gross income less total deductions.
             *   Tax due is equal to the amount obtained by applying the preprinted tax rate to the taxable income amount.
             *   Total tax due equals tax due plus any excess tax collected.
                                           FOR ASSISTANCE, CALL:  City of Mesa(480)644-2316   Fax:(480) 644-3999
SCHEDULE A - DETAILS OF DEDUCTIONS:  Enter below the deductions and exclusions you used in computing your city transaction
privilege tax or use tax.  You must keep a detailed record of all deductions and exclusions.  Failure to maintain proper documentation
and records required by city ordinance may result in their dissallowance.  A separate detail of city records and documentation must be
maintained only when the income, deductions or exemptions are different from state requirements.  
Please note :  Not all deductions are available to all business classifications.
NOTE:  The line numbers at the top of each column below correspond with the line numbers of the business descriptions listed on the front page.

                                               Bus. Class        Bus. Class     Bus. Class              Bus. Class Bus. Class         Bus. Class
                                           Code
                                               LINE 1            LINE 2                          LINE 3 LINE 4            LINE 5      LINE 6
1.  Total tax collected or factored 
     (State, county and city)              64
2.  Bad debts on which tax was paid        53
RETAIL & PERS. PROP. RENTALS
3.  Sales for resale                       54
4.  Repair, service, or installation labor 63
5.  Discounts and refunds                  52
6.  Sales to qualified  health care org.   65
SALES TO U.S. GOVERNMENT
7.  By retailer 50% deductible             75
8.  By manufacturer and repairer 
     (100% deductible)                     75
OUT-OF-STATE SALES
9.  Sales to nonresidents for use out-
     of-state when vendor ships or
     delivers out-of-state.                55
CONSTRUCTION CONTRACTING
10.  35% reduction of gross receipts       70
11.  Exempt sub-contracting income         71
12.  Out-of-City Contracting               62
OTHER DEDUCTIONS
13.  Sales of motor vehicle and use fuel.  59
14.  Sales of exempt machinery & equip.    76
15.  Prescription drugs/prosthetics        58
16.  Food for home consumption             77
17.  Other (explain) _______________       78
18.  Other (explain) _______________       79
19.  Other (explain) _______________       80
20.  Other (explain) _______________       81
Total Deductions
SCHEDULE B
Excess Tax Collected by Business Class
Allowable Credits by Business Class
Jet Fuel      ________gals. X .03=__________  >>>  transfer this amount to line 10 on front page.






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