Wyoming Dept of Revenue
                                                  Wyoming Sales & Use Tax                                   122 W 25th St, 2W
          Form 42-2                               Supplement for Annual Filers                  Cheyenne, WY 82002-0110

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)