Utility Users Tax Form California

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C
O
ITY
F
R
P
V
ANCHO
ALOS
ERDES
Utility Users Tax
Tax Identification No.
5650 Hollis St.
Emeryville, CA 94608
_____________– Phone
_____________– Fax
Reporting Period:
Return Due:
Total Electricity Service Receipts
Tax Rate
3%
Gross Tax
Less: Tax Credits (Attach Documentation)
Net Tax Amount to be Remitted
Name, Title
Date
I hereby declare that all information provided herein is true, complete and accurate to the best of my knowledge.
REMIT TO:
City of Rancho Palos Verdes
Attn: Tax Administrator
30940 Hawthorne Boulevard
Rancho Palos Verdes, CA 90275-5391

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