01-116-B
      (Rev.4-19/16)                                                   FFFF                                    PRINT FORM                                           CLEAR FIELDS
                                                                                                            *01116B0W041916*
Texas List Supplement
- MAQUILADORA -                                                                                 *** INTERNET ***
                                   c. Taxpayer                                             d. Filing period                                                        e.
a.    28120                            number
f. Taxpayer name                                                                                                          g. Due date

                                                                                                              PRINT YOUR NUMERALS LIKE THIS
Do not staple or paper clip.

1. CITY/TRANSIT/COUNTY                               2. CITY/TRANSIT/       3. AMOUNT SUBJECT TO TAX          4. TAX RATE 5. AMT. LOCAL TAX DUE
      /SPD NAME                                      COUNTY/SPD NO.         (Whole dollars only)                          (Multiply Item 3 by Item 4)
                                                                                
                                                                            PLEASE NOTE: 
                                                     You cannot file this supplement unless you hold a Texas 
                                             Maquiladora Export Permit, issued by the Comptroller's office. 
                                                                                 
                                                                      CLICK HERE TO CONTINUE 
                                                                                
      ** Jurisdictions with two asterisks 
                 (        **) next to them indicates                                                 LOCAL TAX
                 you have at least one outlet 
                 within that jurisdiction. You       7b. TOTAL DUE ON THIS PAGE
                 must include the amount 
                 subject to tax for that outlet(s),  You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct 
                 even if the amount is zero.         information we have on file about you.  Contact us at the address or phone number listed in the instructions. 

Form 01-116-B (Back)(Rev.4-19/16)

                                     INSTRUCTIONS FOR COMPLETING
                                 Texas Maquiladora Export Tax Return
                                        List Supplement

Who must file the list supplement? If you hold a Maquiladora Export Permit, you must file the List Supplement to report and pay
the tax required on tax-free purchases that were used or consumed in Texas as required under Tax Code 151.101.

Instructions for filing amended Texas Maquiladora Export Tax Returns - To request forms to file an amended return, call 
1-800-252-5555. Forms may be picked up at the Comptroller field office nearest you.
OR
You may photocopy the original, write "AMENDED RETURN" at the top, strike through Item a, strike through those figures which
have changed and write the new figures on the return.  Sign and date the amended return.

Whom to contact for assistance - If you have any questions regarding the Maquiladora Export Tax, you may contact the Texas 
State Comptroller's field office in your area, or call 1-800-252-5555.  

Item c. Taxpayer  Number  -  If  the  return  is  not  preprinted,      Item 3. AMOUNT SUBJECT TO TAX - Tax must be paid on
  enter  the  taxpayer  number  shown  on  your                                 any  tax-free  purchases  or  goods  that  have  been
  Maquiladora Export Tax permit.                                                used or consumed in Texas. Items may be stored in
                                                                                this state prior to export to Mexico without incurring a
Item d. Filing  Period   -   Filing  period  should  be  entered  if            tax  liability.  If  this  amount  is  negative,  bracket  the
  your return is not already preprinted.  Enter the filing                      amount as follows:  <xx,xxx>.
  period of this report and the last day of the quarter in
  the  space  provided.  Example:  "Quarter  Ending                     Item 4. TAX  RATE  -  Tax  rate  is  the  local  tax  rate  ranging
  03-31-08."                                                                    from  1/4  of  1  percent  to  2  percent.  If  the  form  is
                                                                                preprinted, the tax rate for each local jurisdiction will
Item 1. CITY/TRANSIT/COUNTY/SPD  NAME  -  City/Transit/                         be  printed  on  the  form.  If  the  tax  rate  is  not  pre-
  County/SPD  names  will  be  preprinted  here.  List                          printed, check the booklet, Texas Sales and Use Tax
  additional cities, transit authorities, counties or SPDs                      Rates (96-132), and enter the appropriate tax rate in
  where you did business during the reporting period.                           this column. 

Item 2. CITY/TRANSIT/COUNTY/SPD NO. - The seven-digit                   Item 5. AMOUNT OF TAX DUE - To calculate  the  tax  due,
  number  for  the  local  taxing  jurisdiction  will  be  pre-                 multiply the amount subject to tax (Item 3) by the tax
  printed  beside  the  appropriate  city, transit  authority,                  rate (Item 4). If this amount  is negative,  bracket  the
  county or SPD name. If the local jurisdiction name in                         amount as follows:  <xxx.xx>.
  Item 1  is not  preprinted,  refer  to the  booklet,  Texas 
  Sales  and  Use  Tax  Rates  (96-132)  and  enter  the                Item 7b. TOTAL DUE ON THIS PAGE -    Add  the amounts  in
  appropriate number.                                                           Column  5  and  enter  the  total in Item 7b.  Then  total
                                                                                the local tax (7b) from all pages and enter in Item 3b,
                                                                                Column  b,  of  the  Texas  Maquiladora  Export  Tax
                                                                                Return  (Form  01-126).  If  this  amount  is  negative,
                                                                                bracket the amount as follows:  <xxx.xx>.

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