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AT WHICH PRINCIPAL PRODUCTS ARE SOLD: WHOLESALE RETAIL (A) RETAIL SALES BOTH (B) WHOLESALE SALES 1. GROSS RECEIPTS BOTH SIDES OF THIS FORM MUST BE COMPLETED. (see instruction 5) FEDERAL EMPLOYER I.D.NUMBER 2. LESS DEDUCTIONS (see instruction 5) 3. BALANCE SUBJECT TO FEE (line 1 - line 2) BUSINESS NAME 4. FEE RATE (see instruction 5) .000225 .0003 5. AMOUNT OF FEE DUE (line 3 x line 4) 6. ADD: PENALTY AND INTEREST MAILING ADDRESS (see.

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