PRINT FORM          CLEAR FIELDS
          01-114
          (Rev.4-19/40)                                             DDDD                                                                                                             Instructions in English
Texas Sales and Use Tax Return                                                                                                      b.                                        *0111400W041940*
a.        26100                                                                                                                                     See instructions, Form 01-922.
                                                                   Do not staple or paper clip.                                                     Do not write in shaded areas.                             Page 1 of
c. Taxpayer number
                                                                   d. Filing period                                                                                 e.                          f. Due date

                                                                                                                                                                               Blacken this box if your mailing
                                              Taxpayer name and mailing address                                                                                                address has changed. Show changes
g.                                                                                                                                                                             by the preprinted information.         1.
                                                                                                                                                                               Blacken this box if you are no longer
                                                                                                                                                                               in business. Write in the date you went
                                                                                                                                                                               out of business.                       2.
                                                                                                                                                                               Blacken this box if one of your
                                                                                                                                                                               locations is out of business or has
                                                                                                                                                                               changed its address.                   3.
You have certain rights under Chapters 552 and 559, Government Code, to review, request and correct                                                                       h.        i.
information we have on file about you.  Contact us at the address or phone numbers indicated in the instructions. 

          Return MUST be filed even if no tax is due.                                                                                  l. l. NO SALES - If you had zero to report in Items 1, 2 and 3 for ALL locations  1
                                                                                                                                       for this filing period, blacken this box, sign and date this return and mail it  R
j. Are you taking credit to reduce taxes due on this                                                                                   to the Comptroller's office.
      return? If you are claiming bad debt credit to reduce YES     NO
      your tax due, you must file electronically.              1    2                                                                  PLEASE PRINT YOUR 
k. Did you refund sales tax for items exported outside                                                                                 NUMERALS LIKE THIS
      the U.S. based on a Texas Licensed Customs               YES  NO
      Broker Export Certificate?     (Blacken appropriate box) 1    2                                                             6. Physical location (outlet) name and address Outlet 
          If you answered yes to either question j or k, you must complete                                                            (Do not use a P.O. box address.)           no.
                      Form 01-148 and submit it with your return.
1. TOTAL TEXAS SALES
    (Whole dollars only)       b
      2. TAXABLE SALES
          (Whole dollars only) b                                                                                                  7. AMOUNT OF TAX DUE FOR THIS OUTLET          (Dollars and cents)
      3. TAXABLE PURCHASES                                                                                                            (Multiply "Amount subject to tax" by "TAX RATE" for state and local tax due)
          (Whole dollars only) b                                                                                                    TAX RATES
      4. Amount subject                                                                                                                                                        7a.State tax (include in Item 8a)
          to state tax
          (Item 2 plus Item 3) b                                                                                                  X    .062500                                =
      5. Amount subject to local tax
          (Amount for city, transit,                                                                                                                                            7b.Local tax (include in Item 8b)
          county and SPD must 
          be equal.)           b                                                                                                  X                                           =

      b   26180                                                                     b    STATE TAX - Column a                                                                    b    LOCAL TAX - Column b

       8. Total tax due (from all outlets or list supplements)

          01-114 
          (Rev.4-19/40)              DDDD                           _
       9. Prepayment credit
      10. Adjusted tax due (Item 8 minus Item 9)                    =                                                                                         .                                                       .
                                                                    _                                                                                         .                                                       .
      11. Timely filing discount (0.005)
                                                                    _
      12. Prior payments
      13. Net tax due (Item 10 minus Items 11 and 12)               =                                                                                         .                                                       .
      14. Penalty and interest (See instructions)                   +                                                                                         .                                                       .
                                                                         15a. Total state amount due                                                                           15b. Total local amount due
      15. TOTAL STATE AND LOCAL AMOUNT DUE 
             (Item 13 plus Item 14)                                =
                                                                     b                                                                                                        b
                 Mail to:  Comptroller of Public Accounts
                               P.O. Box 149354
                               Austin, TX  78714-9354
      T Code                  Taxpayer number                                                                              Period      16. TOTAL 
26020                                                                                                                                               AMOUNT(Total of ItemsPAID 
                                                                                                                                              15a and 15b)
Taxpayer name                                                                                                                                                                    n.

I declare that the information in this document and any attachments is true and correct to the best of my knowledge.
          Taxpayer or duly authorized agent                         Date                                                               Daytime phone       (Area code & number)  Make check payable to: 
                                                                                                                                                                                 STATE COMPTROLLER.