Return - Utility Users Tax Form - City Of Alameda
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1Return to:
CITY OF ALAMEDA
2263 Santa Clara Avenue, Room 220
Alameda, CA 94501
RETURN - UTILITY USERS TAX
Company Name:
Tax Period - Calender Month
Mailing Address:
Telephone#
A. REMITTANCE BASED ON COLLECTIONS:
1. Gross Collections
$
2. Other Non-Taxed Collections
$
3. Taxable Collections
$
4. Tax Due (7.5% of line 3)
$
5. Adjustments* (plus or minus)
$
6. Penalty, if due
$
7. Interest, if due
$
8. Total Tax (Sum of lines 4, 5, 6, & 7)
$
B. REMITTANCE BASED ON BILLINGS:
1. Gross Utility
$
2. Gross Charges from Exempt Accounts
$
3. Other Non-Tax Charges
$
4. Taxable Charges
$
5. Tax Due (7.5% of line 4
$
6. Adjustments* (plus or minus
$
7. Penalty, if due
$
8. Interest, if due
$
9. Total Tax (sum of lines 5, 6, 7 & 8)
$
I
declare under penalty of perjury, that to the best of my knowledge and belief, the statements herein and on
attachments are true, correct and complete.
Date:
Title:
Signature:
*Itemize and explain on attachments
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