Form 01-116 Fillable Texas Sales & Use Tax Return List Supplement
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)

SALES AND USE TAX (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (1 CITY / TRANSIT / COUNTY / SPD NAME) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (2 CITY / TRANSIT / COUNTY / SPD NUMBER) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (3 AMOUNT SUBJECT TO TAX (Whole dollars only)) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (4 TAX RATE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (5 AMOUNT OF TAX DUE) (7b TOTAL DUE ON THIS PAGE) (c Taxpayer number) (d Filing period) (f Taxpayer name) (g Due date) (Rev 3 08/13) FFFF 01 116 A 2 CITY/TRANSIT/COUNTY/SPD NO 3 AMOUNT SUBJECT TO TAX 5 AMT OF TAX DUE1 CITY/TRANSIT/COUNTY/SPD NAME 4 TAX RATE(Whole dollars only) (Multiply Item 3 by Item 4) 7b TOTAL DUE ON THIS PAGE Do not staple or paper clip Do not write in shaded areas e d Filing periodc Taxpayernumbera 26120 f Taxpayer name g Due date LOCAL TAX PRINT YOUR NUMERALS LIKE THIS TEXAS LIST SUPPLEMENT You have certain rights under Chapters 552 and 559 Government Code to review request and correctinformation we have on file about you Contact us at the address or toll free number listed on this form