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<br /> I~ISTRIiCTiQlVS <br />PURP®SE AF PQRM. Fhis form Is to be used by the Yebrasiia <br />_;- ;Y' ~ ~ ~ ~ ~ Depa: zmen. of iteven <br />= ue for the hurpuse of norifVrn~: the appropriate <br />~wunty autlturities th at a \orlee of State Tax Caen 4s being filed <br />aga[nst [he [a-Ypayer [n dicated on tEtis form. <br />The tax category nurr, ber codes and the tiebraska tax programs they <br />represent are listed bel ow. <br />i]I ..... ... ................:...Sales Tai <br />U~ Aeruilars U>e Ta.x <br />~'~ - - - - _;;nsumers line ;ax <br />:l; .. - .1~2r1-Irlli tliei <br />=I [raceme Tax Wizh};oiding <br />=-' ~ .. - ..... Inuvidaal Income Tan <br />~~ } iduuary lnc:,me Tax <br />,;t .. - ..... ..L'orporate income and Franchise Tax <br />~6 .. . . . .... .. . .... . ..Documentary St~ttp Taa <br />~ ......... - ..;tlochaut_+-~t; Amusement Device Tax <br /> <br />`~ ..... .. Estate Tax <br />4' .....:... .. _ .......:......':Cigarezce Tax <br />b? .. .-.1,itterFee <br />(rEi ..... , .. .... .:', . .... Lading Tan <br />i Intersxare :Motor Carriers FueCTax <br />3l .. NotarVehicleFuelslmportirygDealer <br />8i Aircraii Fues <br />41 ... . . _Special Fuels <br />~ j <br />~ F <br />n ~ ~ L <br />~ 1 ~~ <br />~ryn/p` "\ ~ { w <br />l` `~ ?1 ~ ~ <br />l` <br />~~ ~ ~, <br />~~ <br />n <br />R V {~ <br />V <br />~ <br />rV w y <br />~ ti <br />a `` }' ' <br /> <br />~ rn <br />, <br />N ~ ~ I <br />~^ <br />~ <br />} ~ ~ <br />_ <br />~5 ~ <br /> T <br />1 <br />r , 0~ <br />~ ~ <br />~ y.. ~~ <br />r ~ l <br />M ' ~ ~~ <br />~ ~a1~* Q <br />~ v l l~ ~,~L.f <br /> ~ <br />Q) ~ ~ t <br /> <br /> d <br />}~.,,~ <br />