Nebraska Nebraska Combined Sales Tax Filing Application

Nebraska Combined Sales Tax Filing Application
Form 11
FORM

Nebraska Combined Filing Application
	1	Federal Employer ID or Social
		Security Number

2	Type of Application
Original

11

Please Do Not Write In This Space

Add Locations to the Combined Return Filed Under:

RESET FORM

________________________________________
3	Indicate Program to be Covered by this Application
Sales and Use Tax (requires electronic filing of returns)

Litter Fee

Name and Location Address

Name and Mailing Address

Name Doing Business As (dba)

Name

Legal Name
Street or Other Mailing Address

Street Address (Do Not Use PO Box)
City

State

Zip Code

City

State

Zip Code

4	Name and Title of Authorized Representative to Contact Concerning this Application
Name

Title

Date
Phone Number

Email Address
5	Location of Records
		 (1)	

Same as Location Address

		 (2)	

Same as Mailing Address

		(3)	

Other, Identify
Address

City

State

Zip Code

6	Enter Business Locations Which will be Reported on the Combined Return
Business Name, Address, City, State, and Zip Code

Nebraska ID Number

Under penalties of law, I declare that I have examined this application, and to the best of my knowledge and belief, it is correct and complete.

sign
here

Signature of Owner, Partner, Corporate Officer,
Member, or Duly Authorized Individual

Title

Date

Phone Number

Email Address

For Nebraska Department of Revenue Use Only
Approved

The combined Nebraska Sales and
Use Tax or Litter Fee ID number is:

Disapproved
Authorized Signature

Date

This application may be faxed to 402-471-5927.
Mail this application to: Nebraska Department of Revenue, PO Box 98903, Lincoln, NE 68509-8903.
6-026-1967 Rev. 6-2017
revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729
Supersedes 6-026-1967 Rev. 6-2015

Instructions
Sales and Use Tax.  Any retailer engaged in business at more than one location must have each retail location licensed
for sales tax. A Nebraska Tax Application, Form 20, must be submitted to obtain a sales tax permit for each retail location.
The permit (license) will identify the ID number assigned to each specific location. The retailer may choose to file a separate
Nebraska and Local Sales and Use Tax Return, Form 10, for each location or request permission to file one return under a
combined ID number. A Form 20 for each location and a Form 11 may be submitted together. Two requirements for combined
filers are that they file electronically and on a monthly basis. This application requests permission from the Nebraska
Department of Revenue (Department) to file a monthly Form 10 under a combined Nebraska ID number. To qualify, each
retail location must have common ownership. “Common ownership” means the same person or persons own at least 80% of
each licensed location. When filing a combined return for sales and use tax, the combined return must be e-filed using the
Department’s NebFile for Business program.
Adding Business Locations.  When completing a Form 20 for a new sales tax location ID that you want to file under an

existing combined ID number, check the box in question 13b(2) and provide the combined ID number. To identify an existing
location ID number that you want to file under a combined ID number, complete lines 2, 3, and 6 on Form 11. Locations that
are added to the combined return will no longer receive individual returns.
Litter Fee.  Unlike the option available to sales tax filers to request to file a combined return, litter fee filers are required to
file a combined return when they have multiple locations with common ownership. Litter fee filers are required to license
each location and are also required to file a combined return for all locations making sales that are subject to litter fee. A
Nebraska Tax Application, Form 20, must be submitted to obtain a litter fee permit for each location. This application is
used to obtain the combined ID number that they will use to file their combined Nebraska Litter Fee Return, Form 28. All
locations filing under the combined return must have common ownership.  “Common ownership” means the same person or
persons own at least 80% of each licensed location.
Restrictions.  A combined ID number will not be assigned from this application until each location listed in line 6 has
applied for its specific location ID number on a Form 20. In addition, the books, records, and accounts of all locations being
combined must be kept at one business location.
If the Form 10 filed under the combined ID number is not filed by the due date, the Department may cancel the retailer’s
authorization to file a combined sales and use tax return and require the filing of a separate Form 10 for each location.
Where to File.  This application may be faxed to 402-471-5927, or be mailed to the Nebraska Department of Revenue,
PO Box 98903, Lincoln, NE 68509-8903.
Do Not Use This Application to Cancel Your Combined ID Number.  The NebFile for Business sales and use tax
program allows cancellation of the combined ID number. On the tax period selection page, check the box asking if your
business has permanently closed or has been sold. To cancel specific location ID numbers that are sold or no longer making
sales, complete a Nebraska Change Request, Form 22.
To cancel the combined litter fee number, check the “discontinuing” block on the face of Form 28 or file a Form 22.
To cancel specific location ID numbers that are no longer making sales subject to litter fee, complete a Form 22 or attach a
list to the Form 28 with each location ID number that should be cancelled.
If there is only one business location still operating after all of the other locations are cancelled, the remaining licensed
location will begin receiving its own preidentified return. 
Specific Instructions
Name and Mailing Address Information.  Print the name and mailing address that you want to be used for information
purposes, since the sales tax combined filers are required to e-file, the returns will no longer be mailed.
Line 1.  Enter the federal employer ID number or Social Security number as shown on your federal income tax return.
Line 2.  Check the type of application requested.
Line 4. The Authorized Contact Person will have the authority to receive the combined ID number assigned from
this application.
Line 6.  List all of the Nebraska ID numbers, names, and location addresses to be reported on the combined return. If there
is not adequate space for a complete list, attach an additional list. If you are submitting the Form 20 to apply for the location
ID numbers at the same time as submitting the Form 11, leave the “Nebraska ID Number” field blank.
Authorized Signature.  This application must be signed by the owner, partner, corporate officer, member, or other individual
authorized to sign by a power of attorney on file with the Department.