Utility Users Tax Remittance Form - City Of Inglewood Revenue Division
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1CITY OF INGLEWOOD
REVENUE DIVISION
UTILITY USERS TAX REMITTANCE FORM
SUPPLIER:
ADDRESS:
TAXING PERIOD:
TAX IS DUE NO LATER THAN THE 20TH OF THE MONTH FOLLOWING MONTH COLLECTED.
TO THE CITY OF INGLEWOOD, FINANCE, ONE MANCHESTER BLVD., INGLEWOOD, CA 90301
TOTAL TAXABLE CHARGES FOR TAXING PERIOD
$
TAX DUE (10% OF TAXABLE CHARGES)
$
PENALTY (10% OF TOTAL TAX DUE); if delinquent
$
INTEREST (0.5% OF TOTAL TAX DUE); if delinquent
$
TOTAL REMITTANCE
$
I declare under penalty of perjury that to the best of my knowledge the foregoing is true and correct.
SIGNATURE:
DATED:
PRINT NAME:
TITLE:
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