Monthly Remittance Of Utility Consumer Tax Form - County Of Spotsylvania Commissioner Of The Revenue
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1MONTHLY REMITTANCE OF UTILITY CONSUMER TAX
DEBORAH F WILLIAMS
COMMISSIONER OF THE REVENUE
PO BOX 175
Account # ___________
SPOTSYLVANIA, VA 22553
540-582-7046 x 687
_________________________________________________
_________________________________________________
Company Name
Trade Name
_________________________________________________
_________________________________________________
Mailing Address
Physical Address
_________________________________________________
_________________________________________________
City
State
Zip
City
State
Zip
_____________________________________________________________________________
SECTION A – REPORTING GROSS
1. Total Gross Receipts for the Month of _________________, 20 ____ . . . . . . . . . . . . . . . . . . .
$ _________________
SECTION B – TAX
2. Total Consumer Tax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ _________________
. . . . . . . . . . . . . . . . . . . . . . . . .
3. Less Allowable Deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . <$ _________________ >
(Credit allowed to subscribers or customers who refuse to pay tax. Attach list.)
4. Sub Total (Subtract Line 3 from Line 2). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ _________________
SECTION C – PENALTY & INTEREST
. Late Payment Penalty & Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
$ _________________
. . . . . . . . . . . . . . . . . . . . . . . .
5
- Due by the last day of the second calendar month after the billing period.
- Late payment penalty is 10% of tax and interest is 10% per year.
- If payment is past due date, please call the Treasurer’s Office for penalty and interest amount. (540) 582-7058
SECTION C- TOTAL DUE
$
TOTAL TAX (plus penalty and interest if applicable) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
110-0000-312-02-01
DECLARATION OF SELLER:
I hereby swear or affirm that the amounts listed above are true, correct and complete to the best of my knowledge and belief
for the period stated above.
Date ___________________
Signed by ________________________________________________________
Phone No________________
Title _____________________________________________________________
Make check payable to: Treasurer, Spotsylvania County.
Mail to: Deborah F Williams, Commissioner of the Revenue, PO Box 175, Spotsylvania VA 22553
The remittance is due on or before the last day of the month following the month being reported. Please return the
original and a copy to the Commissioner’s Office with payment.
FOR OFFICIAL USE ONLY
Date:
____ /____/_____
Late Penalty
Reviewed By: _______________
Payment Enclosed
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Parent category: Financial