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    4                Form                       North Dakota Office of State Tax Commissioner
    5                                                                                                                                                                                                                                                  5
    6                  ST                       Sales, Use and Gross Receipts Tax                                                                                                                                  07162501                            6
    7                                                                                                                                                                                                                                                  7
    8            (A) X Check this box if this is an amended return.                                                                                                                                   (F) X        Check this box if you are no        8
    9                                                                                                                                                                                                              longer in business and enter your   9
    10                                                                                                                                                                                                             last day of business.               10
                 Account                XXXXXXXXX                                             Due                        MM/DD/YYYY
    11                                                                                                                                                                                                                                                 11
    12           Number                                                                       Date                                                                                                                 MM/DD/YYYY                          12

    13                                                                                                                                                                                                (C) X        Check this box if this business has 13
                 Period                 MM/DD/YYYY
    14                                                                                                                                                                                                             changed ownership.  Provide         14
    15           Ending                                                                                                                                                                                            name, address, and telephone        15
    16                                                                                                                                                                                                             number of new owner:                16
    17                                                                                                                                                                                                                                                 17
                 Taxpayer NameXXXXXXXXXXXXXXXXX                                                                                                                                                       NameXXXXXXXXXXXXXXXXXX
    18                                                                                                                                                                                                                                                 18
                 Address1XXXXXXXXXXXXXXXXXXXXXX                                                                                                                                                       AddressXXXXXXXXXXXXXXX
    19                                                                                                                                                                                                                                                 19
                 Address2XXXXXXXXXXXXXXXXXXXXXX                                                                                                                                                       City,State,ZipXXXXXXXX
    20                                                                                                                                                                                                                                                 20
                 City,State,ZipXXXXXXXXXXXXXXXX                                                                                                                                                       (999) 999-9999
    21                                                                                                                                                                                                                                                 21
    22                                                                                                                                                                  Column A                                   Column B                            22
    23                                                                                                                                                                                                                                                 23
                                                                                                                                                                                                                   5% Sales & Purchases
    24                                                                                                                                                                                                                                                 24
    25                                                                                                                                                                                                                                                 25
    26                              (do not include tax)                                                                                                999999999999999                                            999999999999999                     26
               1. Total Sales 
    27                                                                                                                                                                                                                                                 27
               2. Total nontaxable sales                                                                                                                999999999999999                                            999999999999999
    28                                                                                                                                                                                                             999999999999999                     28
               3. Items subject to use tax                                                                                                              999999999999999
    29                                      (add lines 1 and 3, and subtract line 2)                                                                    999999999999999                                            999999999999999                     29
               4. Taxable balance 
               5. State tax 
    30                      (multiply line 4 by the ND tax rate)                                                                                        999999999999.99                                            999999999999.99                     30
    31                                  (add column A and column B from line 5)                                                                                                                                    999999999999.99                     31
               6. Total state tax 
    32                                               - Registered Permit Holders Only (multiply line 6 by .015 ($110.00 maximum) - see instructions)                                                               999999999999.99                     32
               7. Compensation discount 
    33                                       (subtract line 7 from line 6)                                                                                                                                         999999999999.99                     33
               8. Net state tax due
    34         9. Penalty (see instructions)                        (A) 99999999999.99                                                                          (B)         99999999999.99                         999999999999.99                     34
               10. Interest
    35                     (see instructions)                                                                                                                                                                      999999999999.99                     35
    36                                                                                                                                                                                                                                                 36
               11. State tax, penalty, and interest                                                                                                                                                                999999999999.99
    37                                                                                                                                                                                                                                                 37
    38         LOCAL OPTION SALES, USE, & GROSS RECEIPTS TAXES                                                                                                                                                                                         38
    39           To report more than ten local option taxes, see instructions.                                                                                                                                                                         39
    40            A                                  B                                                                     C                                            D                             E            F                                   40
               Local Code               City or County, or Tribal                             Total Local Option Tax                                        Compensation                              Compensation Net Local Option Tax Due
    41                                      Name/Location                                         (Do not enter sales)                                                  Rate                           Allowance   (column C minus Column E)           41
    42                                                                                                                                                          .9999                           999999999.99       999999999.99                        42
                  999      XXXXXXXXXXXXXXXXX                                                  999999999.99
    43                     XXXXXXXXXXXXXXXXX                                                  999999999.99                                                      .9999                           999999999.99       999999999.99                        43
                  999
    44                                                                                        999999999.99                                                      .9999                           999999999.99       999999999.99                        44
                  999      XXXXXXXXXXXXXXXXX
                  999      XXXXXXXXXXXXXXXXX                                                  999999999.99                                                                                      999999999.99
    45                                                                                                                                                          .9999                                              999999999.99                        45
    46            999      XXXXXXXXXXXXXXXXX                                                  999999999.99                                                      .9999                           999999999.99       999999999.99                        46
    47                                                                                        999999999.99                                                      .9999                           999999999.99       999999999.99                        47
                  999      XXXXXXXXXXXXXXXXX
    48                                                                                        999999999.99                                                      .9999                           999999999.99       999999999.99                        48
                  999      XXXXXXXXXXXXXXXXX
    49                                                                                        999999999.99                                                      .9999                           999999999.99       999999999.99                        49
                  999      XXXXXXXXXXXXXXXXX
    50                                                                                        999999999.99                                                      .9999                           999999999.99       999999999.99                        50
                  999      XXXXXXXXXXXXXXXXX
    51                                                                                        999999999.99                                                      .9999                           999999999.99       999999999.99                        51
                  999      XXXXXXXXXXXXXXXXX
    52                                                                                                                                                                                                                                                 52
    53                                                                                                                                                                                                             999999999999.99                     53
               12. Net local option tax due
    54                                                                                                                                                                                                             999999999999.99                     54
               13. Total local option penalty and interest
    55                                               Make check or money order payable to North Dakota Tax Commissioner.                                                                                           999999999999.99                     55
               14. Total due with return.  
    56                                                                                                                                                                                                                                                 56
    57         I declare that this return has been examined by me and to the best of my knowledge and                                                                                                 This space is for Tax Department use only        57
    58         belief is a true, correct, and complete return.                                                                                                                                                                                         58
    59         Taxpayer signature                                   Date                                             Title                                                                                                                             59
    60                                                                                                                                                                                                                                                 60
    61         Contact person (please print or type)                                                                 Contact telephone number                                                                                                          61
    62                                                                                                                                                                                                                                                 62
                                                            Mail to: Office of State Tax Commissioner,
1 2 3  645 6 7 8 9   07/201610  12  14  16  18  20  22  24  26 PO28 BOX30  32 5623,34  36  38 Bismarck40  42  44  46 ND48  50 58506-562352  54  56  58  60  62  64  66  68  70 NACTP72  74  76  78  80                                                 64 84
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    65                                                                                                                                                                                                                                                 65
    66                                                                                                                                                                                                                                                 66

    Form             North Dakota Office of State Tax Commissioner
     ST              Sales, Use and Gross Receipts Tax

(A) Check this box if this is an amended return.                                                (F)                      Check this box if you are no
                                                                                                                         longer in business and enter your
                                                                                                                         last day of business.
Account                                            Due
Number                                             Date
Period                                                                                          (C)                      Check this box if this business has
                                                                                                                         changed ownership.  Provide
Ending                                                                                                                   name, address, and telephone
                                                                                                                         number of new owner:

                                                                                    Column A                             Column B
                                                                                                                         5% Sales & Purchases

1.  Total Sales (do not include tax)
2.  Total nontaxable sales
3.  Items subject to use tax
4.  Taxable balance (add lines 1 and 3, and subtract line 2)
5.  State tax (multiply line 4 by the ND tax rate)
6.  Total state tax (add column A and column B from line 5)
7.  Compensation discount - Registered Permit Holders Only (multiply line 6 by  015 ($110 00 maximum) - see instructions)
8.  Net state tax due (subtract line 7 from line 6)
9.  Penalty (see instructions)          (A)                                       (B)
10.  Interest (see instructions)
11.  State tax, penalty, and interest
LOCAL OPTION SALES, USE, & GROSS RECEIPTS TAXES
To report more than ten local option taxes, see instructions.
A                                     B                     C                        D          E                        F
Local Code         City or County, or Tribal       Total Local Option Tax         Compensation Compensation              Net Local Option Tax Due
                     Name/Location                 (Do not enter sales)             Rate         Allowance               (column C minus Column E)

12.  Net local option tax due
13.  Total local option penalty and interest
14.  Total due with return.  Make check or money order payable to North Dakota Tax Commissioner.

I declare that this return has been examined by me and to the best of my knowledge and         This space is for Tax Department use only
belief is a true, correct, and complete return.
Taxpayer signature                      Date                Title

Contact person (please print or type)                       Contact telephone number

    07/2016                             Mail to: Office of State Tax Commissioner,
                                        PO BOX 5623, Bismarck ND  58506-5623

Form ST - Sales, Use, and Gross Receipts Tax Return  instructions
General and specifi c line instructions for Form ST

General instructions                                         Form ST                         Line 3 – Enter the cost of taxable goods and 
                                                                                             equipment consumed or used by you that 
Every permit holder must  file a                       Do’s and Don’ts                        was purchased without tax.  For example, 
return for each reporting period even        Do                                              items removed from inventory and used 
if no sales were made or no tax is           • Complete and return original forms           by you.  
due.  
                                               provided by the Tax Commissioner.             Line 4 – Add lines 1 and 3, and subtract 
   A preprinted return, instructions, and 
                                             • Print in blue or black ink.                  line 2.  Enter the result on line 4.
return envelope are mailed in the fi nal 
week of the reporting period to every        • Print neatly within the designated           Line 5 – Multiply line 4 by the applicable 
registered permit holder that fi les a paper    spaces.                                       tax rate and enter the result on line 5.   
return.  DO NOT mail a paper return if you   • Round all values in lines 1 through 4 to     Line 6 – Add column A and B on line 5 and 
fi le electronically. For information about     the nearest whole dollar.                     enter a ount on line 6.
                                             •Enter dollars and cents in lines 5 
electronic fi ling see www.nd.gov/tax.                                                        Line 7 –  All registered permit holders 
                                               through 14 and for all local tax data.
   Please review the preprinted copy of your                                                 regardless of fi ling frequency, will receive 
return before completing it.  The original                                                   compensation on each properly fi led 
                                             Don’t
return has been preprinted specifi cally for                                                  return.  The amount of compensation 
                                             •Don’t enter dollar signs ($), commas (,), 
your business.                                 or decimal points (.).                        your company will receive is computed 
All returns are due the last day of          • Don’t use dashes or other symbols to         by multiplying the total state tax on 
the month following the reporting              indicate you do not have an entry.            line 6 times 1.5 percent (.015) and enter 
period.                                      • Don’t use pencil or light colored ink.       the result on line 7. Effective with the 
    To avoid penalty, the return must be     • Don’t use Column A unless reporting a        July 1, 2013 return, the compensation 
postmarked by the US Postal Service on or      state tax rate other than 5%.                 may not exceed $110.00 per return.  
before the due date and paid in full with a                                                  Compensation may not be deducted if 
valid check or money order.                                                                  the return is fi led after the due date or is 
For best results, complete the               occurring within the Standing Rock Sioux        not paid in full.  Penalty and interest will 
original customized form and mail it         Reservation will be included in “Total Sales”   be assessed on tax due resulting from 
in the return envelope provided.             and, when applicable, in the “Nontaxable        compensation deduction on a late fi led 
   DO NOT send photocopies.  Returns         Sales” and “Items Subject to Use Tax” lines     or underpaid return.  Please contact our 
generated from a software package are        of the Form ST - Sales, Use, and Gross          offi ce if a return needs to be amended to 
acceptable if the Tax Commissioner has       Receipts Tax return.                            ensure the proper vendor compensation 
pre-approved the form and the required       In addition to the tribal imposed 5             rate is used. 
identifying information is provided.         percent sales and use tax, 7 percent alcohol    Line 8 – Subtract total compensation on line 
If you use an approved software              gross receipts tax, and 3 percent new farm      7 from line 6 and enter the result on line 8. 
package to prepare your return it            machinery, new farm irrigation, and new         Line 9 – Calculate penalty if fi ling a late 
is essential to enter the following          manufactured homes gross receipts tax, the      return.
identifying information properly:            Standing Rock Sioux Tribe also imposed a 
                                                                                               • For the fi rst month the return is late, the 
• Account number.  Enter the account        one-fourth percent .25 percent tribal local 
                                                                                             penalty is 5 percent of the state tax on 
 number as shown on your preprinted          tax that will apply to all transactions subject 
                                                                                             line 5 or $5, whichever is greater.
 form.                                       to the state-level taxes.
                                                                                               • For each additional month or fraction 
• Period ending. Enter the last day of the  The .25 percent local tribal tax will be 
                                                                                             of a month the return is late, add an 
 tax-reporting period.                       reported separately in the Local Option 
                                                                                             additional penalty of 5 percent of the 
• Name and Address. Enter the taxpayer      Sales, Use, and Gross Receipts Taxes 
                                                                                             state tax on line 5 up to a maximum of 
 name and address.                           section of the sales tax return.  Although 
                                                                                             25 percent.
                                             all transactions on the reservation will be 
Line instructions - State and                subject to the .25 percent local tribal tax,    If items (a) and (b) of line 9 are fi lled with 
Tribal Taxes                                 the tax associated with 5, 7 or 3 percent       XXXs, calculate penalty on the total state 
                                             sales will each be reported on separate lines   tax (line 6) and enter in line 9, column B.  If 
Standing Rock Sioux Tribe                    of the Local Option Sales, Use, and Gross       items (a) and (b) are blank, calculate penalty 
   Effective July 1, 2016, the Standing      Receipts Taxes section of the Form ST sales     on the state tax (line 5) separately for each 
Rock Sioux Tribe will impose a 5 percent     tax return.                                     column, enter the penalty amounts in items 
                                                                                             (a) and (b), and enter the total penalty in 
sales and use tax, a 7 percent alcohol gross Line 1 - Enter the total sales for the 
                                                                                             line 9, column B.
receipts tax, and a 3 percent new farm       reporting period.  Do not include the sales 
machinery, new farm irrigation, and new      tax in this amount.                             Line 10 – If fi ling a late return, enter the 
manufactured homes gross receipts tax that                                                   amount of interest due.  Interest does not 
are identical to North Dakota’s sales, use,  Line 2 - Enter the total nontaxable sales.  
                                                                                             apply to the fi rst month a return is late, but 
and gross receipts taxes.                      See Exemptions Guideline.                     applies at a rate of 1 percent each month 
   When reporting state-level taxes (5, 7 or                                                 or fraction of a month the return remains 
3 percent), no distinction is made between                                                   late or unpaid.
the North Dakota state taxes and Standing                                                    Line 11 – Add lines 8, 9, and 10.  Enter the 
Rock Sioux Tribe taxes.  All transactions                                                    result on line 11.

Local option sales, use, and gross                                     • If you use Schedule ST-Local, all local                              Column F—Net local option tax due
receipts taxes                                                            codes, city/county/tribal names, and                                 Subtract the compensation in column E from 
   Local option taxes include city, county, and                           compensation rates are preprinted on the                             the total local tax in column C and enter the 
tribal taxes that are due in addition to state-level                      schedule.  Additional ST-Local Schedules and                         result.  
North Dakota and tribal taxes.  If you reported                           instructions are available at www.nd.gov/tax or 
                                                                                                                                               Line 12—Net local option tax due
more than ten local taxes in the past year, use the                       by calling 701-328-1246.
                                                                                                                                               Add all of the amounts in column F and enter 
Schedule ST-Local included with your return to                         •If you report local taxes in the Local Option 
                                                                                                                                               the result.  This is the total amount of local tax 
report all local taxes due.  If you reported ten or                       Tax section on Form ST, and you are reporting 
                                                                                                                                               due with the return.
less local option taxes in the past year, the Local                       a local tax for the fi rst time, enter the local tax 
Option Tax section on Form ST is  preprinted                              code, name of the city, county or tribal and                         Line 13—Local option penalty and 
with information regarding each local jurisdiction                        compensation rate from the list at the bottom                        interest  
you reported.                                                             of these instructions.                                               If the return is unpaid or fi led after the due 
   The Schedule ST-Local lists the cities,                                                                                                     date, a local penalty is due.  Penalty and interest, 
counties, and tribal taxes without compensation                        Column C—Total local option tax
                                                                                                                                               including the minimum $5 penalty, applies 
on page 1 and the cities and counties with                                Enter the total amount of tax due for each                           separately to each jurisdiction with local tax due. 
compensation on page 2.  Additional instructions                       city, county or tribe.  The tax due is equal to                         On line 13, enter the total amount of all penalty 
are available on the department’s web site or by                       the correct amount of local sales or use tax you                        and interest due on local taxes.
contacting our offi ce.                                                 should have charged on sales made within the 
                                                                       local jurisdiction plus any local use tax due on                        Line 14—Total due with return  
Instructions for reporting local option 
taxes:                                                                 untaxed goods or services subject to use tax                            Add lines 11, 12, and 13 to calculate the total 
                                                                       because they were stored, used or consumed                              amount due with the return.
• Report all local tax amounts in dollars and                         within the local jurisdiction.                                          Make your check payable to North 
   cents.
• Report all local taxes in one place.  Do not                        Column E—Compensation allowance                                         Dakota Tax Commissioner.  
   report some local taxes on Form ST and other                           Some local jurisdictions provide compensation                        The taxpayer or taxpayer’s agent must sign 
   local taxes on Schedule ST-Local.  If reporting                     to permit holders for collecting and remitting                          the return.  Please PRINT the name, title and 
   ten or less local taxes, use the Local Option                       local tax.  Multiply the tax in column C times the                      phone number of a contact person who can 
   Tax section on Form ST.  To report more than                        compensation rate in column D.  Compensation                            answer questions about this return.
   ten local taxes, report all on Schedule ST-                         may not exceed the maximum amount listed 
                                                                                                                                               O  ffice of State Tax Commissioner
   Local.                                                              below and is not allowed if the return is late or                       PO Box 5623
                                                                       underpaid.  Note:  If amount in column C is                             Bismarck, ND 58506-5623
                                                                       negative, enter zero in column E.                                       Phone: 701.328.1246 
                                                                                                                                               www.nd.gov/tax
                     Local Option Taxes: Code/Jurisdiction Name/Compensation Rate/Tax Rate
237  Alexander 0..............2%   209  Drake 0.....................2% 202  Hannaford 0.............1%    193  Maddock 0...............2%     189  Oxbow 0.................... 1% 503  Steele County 0........1%
220  Anamoose 0.............1%     157  Drayton 0..............1½%     112  Harvey 3...................2% 108  Mandan 3..............1¾%      208  Page 0........................ 2% 120  Strasburg 2...............2%
203  Aneta 0.....................1%204  Dunseith 0................1%   222  Harwood0................1%    218  Mapleton 0............1½%      130  Park River 0.............. 2% 223  Streeter  ..................1%0
162  Ashley 1...................1% 148  Edgeley 2.................2%   164  Hatton0....................2% 227  Max 0.......................1% 119  Pembina 0.............. 2½% 231  Surrey  ....................2%0
156  Beach 0....................1% 176  Edinburg 0................1%   180  Hazelton 2................2%  150  Mayville 0................2%   151  Portland 0.................. 2% 132  Tioga 0..................2½%
133  Belfi eld 0..................2%179  Elgin 0......................1%134  Hazen 3.................1½%   140  McClusky 0..............1%     154  Powers Lake 3........... 1% 195  Tower City 0............2%
138  Berthold 0................1%  131  Ellendale 2...............1%   142  Hettinger 0............1½%    188  McVille 0.................2%   232  Ray 0......................... 2% 170  Towner 2..................1%
200  Beulah 2...................2% 166  Enderlin 0.................2%  168  Hillsboro 0...............2%  178  Medora 0...............2½%     198  Reeder 0.................... 1% 182  Turtle Lake 0............2%
229  Bisbee2....................2% 206  Fairmount 0..............2%    172  Hoople 3...................1% 187  Michigan 0...............2%    152  Regent 0.................... 2% 211  Underwood ............2%0
102  Bismarck 3...............1%   105  Fargo 0.....................2% 185  Hope 0......................2%169  Milnor 0................1½%    159  Richardton 0.............. 2% 113  Valley City 0.........2½%
122  Bottineau 2...............2%  167  Finley 0....................2% 110  Jamestown 0.............2%    214  Minnewaukan0........2%         199  Rolette 0.................... 2% 175  Velva 0.....................2%
126  Bowman 0................1%    221  Forman 0...............1½%     117  Kenmare 0................2%   103  Minot 0.....................2% 125  Rolla 0....................... 2% 111  Wahpeton 6..............2%
196  Buffalo 3..................2% 177  Fort Ransom 0..........2%      135  Killdeer 0.................2% 216  Minto 3.....................1% 118  Rugby 2..................... 2% 160  Walhalla 0................2%
506  Burleigh County 3...½%        235  Fredonia 0................2%   230  Kindred 0.................2%  114  Mohall 0...................1%  190  Scranton 0................. 1% 502  Walsh Co.  0............¼%
161  Cando 2....................2% 210  Gackle 0...................1%  165  Kulm 0.....................2% 507  Morton County 3.....½%         233  South Heart 0............ 2% 505  Ward County  0.......½%
124  Carrington 0.............2%   139  Garrison 0................2%   213  Lakota 0...................1% 153  Mott 0.......................2%186  St. John 3.................. 1% 183  Washburn  ..............2%3
191  Carson 0...................1% 219  Glenburn 0...............2%    149  LaMoure0................2%    173  Munich 2..................1%   700  SRST-5% Sales 0..... ¼% 171  Watford City 3......1½%
501  Cass County 0.........½%      212  Glen Ullin 0.............1%    123  Langdon 3................2%   144  Napoleon 2...............2%    701  SRST-7% Alcohol 0¼% 129  West Fargo  ............2%0
163  Casselton 0...............1%  107  Grafton 3...............2½%    128  Larimore0................1%   201  Neche 0....................2%  702  SRST-3% New Farm                  226  Westhope 0 ...............1%
127  Cavalier 0.................2% 101  Grand Forks 5.......1¾%        234  Leeds 0.....................2%194  New England0.........2%             Machinery, New                    504  Williams County 0...1%
238  Center 0....................2%225  Granville 0...............2%   215  Leonard 0.................2%  174  New Leipzig 0..........1%           Farm Irrigation,                  109  Williston 3................2%
141  Cooperstown 0......1½%        192  Grenora 0.................1%   181  Lidgerwood 0...........2%     145  New Rockford 0.......2%             & Manufactured                    184  Wilton 3...................2%
116  Crosby 0...................3% 207  Gwinner 0................2%    236  Lignite 0...................2%217  New Salem 0............1%           Homes 0................... ¼% 205  Wimbledon 0............1%
104  Devils Lake 3...........2%    143  Halliday 0.................1%  121  Linton 2....................2%197  Northwood 0.........1½%        137  Stanley 3................ 1½% 155  Wishek  ...............1½%3
106  Dickinson 0...........1½%     158  Hankinson 4.............2%     136  Lisbon 0...................2% 146  Oakes 3....................2%  147  Steele 0...................... 2% 224  Woodworth 0............1%
                                                                                                                                                                                     228  Wyndmere 0 .............2%

 0   The Local tax ordinance does not provide for permit holder compensation.
 1   Compensation rate is 3% up to a maximum amount of $33.33 on a monthly return or $100 on a quarterly return.
 2   Compensation rate is 3% up to a maximum amount of $50 on a monthly return or $150 on a quarterly return.
 3   Compensation rate is 3% up to a maximum amount of $83.33 on a monthly return or $250 on a quarterly return.
 4   Compensation rate is 3% with no maximum.
 5   Compensation rate is 5% up to a maximum amount of $166.67 on a monthly return or $500 on a quarterly return.
 6   Compensation rate is 3% up to a maximum of $37.50 per month.

                    O  ffice of State Tax Commissioner, PO Box 5623, Bismarck, North Dakota 58506-5623
                                                                      Phone: 701.328.1246, www.nd.gov/tax
21997
(Instructions revised 7/16)