Utility User Tax Collection Report Form - City Of Sacramento
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2CITY OF SACRAMENTO
UTILITY USER TAX COLLECTION REPORT
COMPANY NAME _____________________________________ TAX PERIOD COVERED _______________________
ADDRESS
____________________________________ TYPE of UTILITY SERVICE ______________________
CITY, STATE, ZIP _____________________________________FIEN NO. ____________________________________
PHONE NO.
_____________________________________CONTACT PERSON ____________________________
Please submit separate reports for each category of utility service provided. The information provided in this report will be
maintained as confidential under Revenue and Taxation Code Section 7284.6.
Remittance Based Upon Utility Billing
1.
Gross Charges (including taxes and surcharges)
$________________________
2.
Deductions
a.
Taxes (federal, state, 911 tax)
$________________________
b.
Sales for Resale
$________________________
c.
Exempt Accounts
$________________________
d.
Other non-taxed charges *
$________________________
3.
Adjustments * (plus or minus)
$________________________
4.
Net Taxable Charges (line 1 minus lines 2 + 3)
$________________________
5.
Local Tax Due (at 7.5% of line 4 – Gas, Electric, Cable Television)
(at 7.0% of line 4 – Communications Services)
$________________________
6.
Penalties/Interest **
$________________________
0.00
7.
Total local tax due (sum lines 5 and 6)
$________________________
* Attach a description of any adjustments or services not subject to the local tax as referred to on lines 2d and 3.
** A 15% penalty and 1% monthly interest charge shall apply if payment is not received by the City by the last day of the month
following the reporting period.
I declare, under penalty of perjury, that to the best of my knowledge and belief the statements herein, and any attachments
hereto, are true and correct.
Date:____________________________________ Signed:_________________________________________________
Phone:___________________________________ Print Name/Title:__________________________________________
Mail Report & Remittance to: City of Sacramento, Revenue Division, 915 “I” Street, Room 1214, Sacramento, CA 95814-2604
For Questions, call:
(916) 808-8500 or 808-5833
(Revised 1208)
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