2 Original F-72 Instrument

Generic Clearance for Internet Nonprobability Panel Pretesting

Original blank F72.xlsx

QTAX F-72 Redesign Cognitive Testing

OMB: 0607-0978

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OMB No.: 0607-0112 Approval Expires: 08/31/2022


ID
State name


Period covered by this
Calendar Qtr. 1st-2019
021-000-000




report-------------------------->
Fiscal Qtr.

TAX COLLECTIONS





Omit cents









( Net of refunds except when otherwise indicated)








Please report either in terms of 3-month totals or








in terms of individual month amounts whichever is








more convenient.




Total January February March
1. Property taxes









a. Directly State-collected


T01




b. Received from local government collection








agencies


T02



2. General sales and gross receipts taxes








(and related use taxes)








a. State imposed taxes (plus any retained








portion of local supplements)












T09




Collections of locally imposed supplements








to State general sales taxes (net of








State-retained amount)







3. Motor fuel sales taxes









a. Gross collections








b. refunds during period








c. Net collections-(a minus b)


T13



4. Selective sales and gross receipts taxes,








other than motor fuel









a. Alcoholic beverages


T10




b. Public utilities


T15




c. Insurance


T12




d. Tobacco products


T16




e. Pari-mutuels


T14




f. Amusements


T11



g. Other selective sales and gross receipts



T19



5. License taxes








a. Alcoholic beverages


T20




b. Public utilities


T27




c. Motor vehicle


T24




d. Motor vehicle operator


T25




e. Corporations in general


T22




f. Hunting and fishing licenses


T23




g. Amusements


T21




h. Occupation and business licenses not








elsewhere classified


T28




i. Other licenses taxes


T29



6. Individual income taxes









a. Gross collections








b. Refunds during period








c. Net collections-(a minus b)


T40



7. Corporation net income taxes













T41



8. Death and gift taxes













T50



9. Severance taxes













T53



10. Documentary and stock transfer taxes












T51



11. Other miscellaneous taxes













T99



CENSUS USE ONLY





13. Remarks






T77 Local
12 Name




Total 0
DATA Title Manager, Systems Control and Reporting






SUPPLIED Email







BY









Telephone Area Code Number
Extension




















































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