Wyoming Dept of Revenue
                                                     Wyoming Sales Tax Supplement                                122 W 25th St, 2W
                            Form 43-2                for Occasional Vendors                                      Cheyenne, WY 82002-0110 
                            ĸ )RU 'HSW 8VH 2QO\ ĺ

Please use black ink to complete form
                                                                   Ownership RID: 

                                                                   License Number: 
              Name & Address
                                                                   Report Period:                through 
                                                                   Return Due Date: 
                                                                              &KHFN KHUH LI WKLV LV DQ DPHQGHG UHWXUQ ĺ 

Part III - Additional Jurisdictional Tax Information

(Column 1)                  (Column 2) (Column 3)    (Column 4)    (Column 5) (Column 6)                         (Column 7)
Jurisdiction
Name Code                   Jurisdiction Tax Rate    Sales Tax Due NOT USED   Excess                             Net Tax Due 
(Use CAPS)
                            Digit Code   % in Effect                          Tax Due                            (Add Columns 4 & 6)
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %
                                                 %

                            Line 1. Total Net Tax (Add Totals in Column 7. Enter on Part II, Line K of Form 43-1)