CITY OF HELENA, ALABAMA 
                                                    SALES, USE, LEASE/RENTAL TAX REPORT 
                                                                                                                                                 MAIL FORM W/REMITTANCE TO:                       
                                                                                                                                                 CITY OF HELENA            
      REPORTING PERIOD: _________________________                                                                                                PO BOX 613                     
                                                                                                                                                 HELENA, AL  35080-0613 
                                                                                                                                                 PH:205.663.2161  FAX: 205.663.9276 
                                                    
                                                                                                                                                 TOTAL AMOUNT ENCLOSED 
      TAXPAYER  NUMBER_____________________________________                                                                                       
                                                                                                                                                                                                  
      TAXPAYER NAME: 
                                ADDRESS  
 
        CHECK HERE IF THIS IS FINAL TAX  RETURN 
                                                             (A)                      (B)                                                        (C)           (D)         (E) 
       TYPE OF TAX/ TAX AREA                        GROSS TAXABLE                     TOTAL                                                      NET TAXABLE   TAX        GROSS TAX DUE 
                                                          AMOUNT           DEDUCTIONS         (COLUMN A – COLUMN B)                                            RATE       (COLUMN C x COLUMN D) 
              SALES - Automotive                                                                                                                               1.33%        
             SALES- Farm / Machinery                                                                                                                           1.33%        
             SALES- General                                                                                                                                    4%           
                                                                                                                                                                            
       SELLERS USE -Automotive                                                                                                                                 1.33%        
      SELLERS USE –Farm / Machinery                                                                                                                            1.33%        
             SELLERS USE -General                                                                                                                              4%           
      CONSUMERS USE- Automotive                                                                                                                                1.33%        
      CONSUMERS USE- Farm / Machinery                                                                                                                          1.33%        
       CONSUMERS USE- General                                                                                                                                  4%           
                                                                                                                                                                            
       LEASE/RENTAL - Automotive                                                                                                                               2%           
             LEASE/RENTAL - General                                                                                                                            2%           
                                                                                                                                                                            
    POLICE JURISDICTION-  list type below                                                                                                                      Rate x 0.5   
                                                                                                                                                                
 ** IN ACCORDANCE WITH STATE TAX STATUTES, DISCOUNT DOES  (1) TOTAL TAX DUE                                                                                                                          
 NOT APPLY TO LEASE/RENTAL/USE TAX TYPES                                                   (TOTAL OF COLUMN E) 
 This return must be postmarked by the 20 thday of the month following the 
 reporting period for which you are filing to be considered a timely return.  Seller  (2) PENALTY                                                                                                
 must file timely returns, even though no taxes are due.                                     (ITEM 1 X 10%)  
  
                                                                                      (3) INTEREST                                                                                               
                                                                                            (ITEM 1 x 1% PER MONTH DELINQUENT) 
 By signing this report I am certifying that this report, including any 
 accompanying schedules or statements, has been examined by me and is to              (4) DISCOUNT ** 
 the best of my knowledge and belief, a true and complete report for the                    IF SUBMITTED PRIOR TO FILING DEADLINE                                                                
 period stated above.                                                                  5% ON $100 OR LESS – 2% OVER $100 ($400 max.) 

                                                                                       (5) NET TAX DUE                                                                                           
                                                                                              (ITEM 1 - 4; IF DELINQUENT 1 + 2 + 3) 

 DATE:_____________________________ TITLE: _________________                           
                                                                                            TOTAL AMOUNT DUE & ENCLOSED                                                                          
 SIGNATURE: ______________________________________________                             
 

Sales/Use Tax 
Automotive rate includes new and used automotive vehicles, truck trailers, semi-trailers, and mobile homes.  General rate includes equipment 
and replacement parts used in agriculture production, machines and replacement parts used in manufacturing, compounding, mining and 
quarrying, gross receipts from places of amusement and entertainment devices, and all other tangible personal property. 
 
Rental Tax 
Due from the lessor on the total gross receipts from rentals in Helena. 
                                                                               
                                                STANDARD DEDUCTION SUMMARY TABLE  
        (SUMMARY BELOW MUST BE COMPLETED TO CORRESPOND WITH TOTAL DEDUCTIONS ON FRONT OF TAX REPORT) 
 TYPE OF TAX  WHOLESALE          AUTO    LABOR/NON       SALES DELIV               SALES TO GOVT             GAS OR      OTHER ALLOWABLE         TOTAL 
              SALES           TRADE-INS  TAXABLE SERV  OUTSIDE JURIS.  OR ITS AGENCIES  LUBE OILS                        DEDUCTIONS (1)          DEDUCTIONS 
                                                                                                                                                         
  TOTAL                                                                                                                                                  
 DEDUCTIONS                                                                                                                                              
 
INSTRUCTIONS & INFORMATION CONCERNING THE COMPLETION OF THIS REPORT 
 
    To avoid the application of penalty and/or interest amounts, this report must be filed on or before the 20 thday of the month following the period for which 
     the report is submitted.  Cancellation postmark will determine timely filing. 
    A remittance for the total amount due made payable to the tax jurisdiction must be submitted with the report. 
    This report should be submitted on a monthly basis unless you have requested and been approved for a different filing frequency. 
    Any credit for prior overpayment must be approved in advance by the taxing jurisdiction. 
    No duplicate or replicated forms except with permission of tax jurisdiction. 
 
                                 INDICATE ANY ACCOUNT CHANGES BELOW 
 
     Business Name: ___________________________________         Physical Address: ____________________________________ 
 
    Mailing Address: __________________________________          City: ______________________ State: _____  Zip: _________ 
      
    Phone Number: _______________  Fax Number: ___________________  Contact Person: _______________________________