Wyoming Dep
                                                  Wyoming Sales & Use Tax                              artment of Revenue 
                                                                                                122 W 25th St, Suite E301 
          Form 42-2                               Supplement for Annual Filers                     Cheyenne, WY 82002

Please use black ink to complete form
Name                                                             Ownership RID: 
                                                                 License Number: 
                                                                 Report Period:            through 

Part III - Jurisdictional Tax Information - Do not use dollar signs, commas or periods
Col 1        Col 2        Col 3          Col 4             Col 5         Col 6       Col 7             Col 8
Jurisdiction Jurisdiction Tax Rate    Select quarter(s)    Sales Tax Due Use Tax Due Excess        Net Tax Due 
Name Code    Digit Code   % in Effect where taxes were 
(Use CAPITAL                          collected at rate in                           Tax Due    (Add Columns 
letters)                                 Column 3                                                  5, 6, & 7)
                                      Q1 Q2 Q3    Q4
                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

                                %

             Line 1.Total Net Tax (Add totals in Column 8, move to Part II, Line J of Form 42-1)

                                                                                                       Revised 1.23.2020