Sales & Use Tax Return Form - City Of Delta Page 2

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BE SURE TO REVERSE CARBON BEFORE FILLING OUT THESE SCHEDULES
SCHEDULE - B - CITY USE TAX
SCHEDULE - C - CONSOLIDATED ACCOUNTS REPORT
This schedule is required in all cases in which the taxpayer makes a consolidated return, which includes sales made at more
The Delta Municipal Code imposes a tax upon the privilege of using, storing, distributing or otherwise consuming tangible
than one location. It must be completely filled out and convey all information required in accordance with the column head-
personal property or taxable services purchased, rented or leased.
ings. If additional space is needed, attach schedule in same format.
PERIODS TOTAL GROSS
PERIODS NET TAXABLE
DATE OF
NAME OF VENDOR
TYPE OF COMMODITY
PURCHASE
ACCOUNT
BUSINESS ADDRESSES
SALES (AGGREGATE TO
SALES (AGGREGATE TO
PURCHASE
ADDRESS
PURCHASED
PRICE
NUMBER
OF CONSOLIDATED ACCOUNTS
LINE 1 FRONT OF RETURN)
LINE 4 FRONT OF RETURN)
$
$
LIST OF PURCHASES (IF ADDITIONAL SPACE IS NEEDED, ATTACH SCHEDULE IN SAME FORMAT)
$
TOTAL PURCHASE PRICE OF PROPERTY SUBJECT TO CITY USE TAX
(ENTER ON LINE 10 ON FRONT OF RETURN)
$
$
$
TOTALS (ENTER ON FRONT OF RETURN)
SHOW BELOW CHANGE OF OWNERSHIP AND/OR ADDRESS, ETC.
I hereby certify under penalty of perjury, that the statements made
NEW BUSINESS DATE
1. If business ownership has changed, give date of change and
herein are to the best of my knowledge, true and correct.
NAME ___________________________________________________
MO.
DAY
YR.
new owners name, address and phone.
SIGNED BY ___________________________________________________
2. If business has been permanently discontinued, give date
ADDRESS _______________________________________________
discontinued.
PRINT NAME __________________________________________________
_________________________________________________________
DISCONTINUED DATE
3. If business location has changed, give new business address
MO.
DAY
YR.
TITLE ________________________________________________________
and mailing address.
PHONE __________________________________________________
PHONE ___________________________________
__________________
BUSINESS ADDRESS
MAILING ADDRESS
DATE

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