Food And Beverage Tax Remittance Form - City Of Salem - 2017

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2017
2017
CITY OF SALEM
FOOD AND BEVERAGE TAX REMITTANCE FORM
Owner Name, Trade Name & Address
Filing Month
RBS Account #
(FEDERAL ID IR SSN IF NO ACCOUNT #)
Location
Phone:
E-Mail
1. Gross Sales of Food and Beverage
2. Allowabe Deductions
A.Meals to Employees when no charge is made
$
B. Meals paid for by Federal, State, or Local Gov.
$
C. Meals sold in coin operated Vending Machines
$
D. Non-Food Merchandise/Prepackaged Items
$
E. Other(Explain)
$
3. Total Deductions(Sum of 2A - 2E)
4. Taxable Sales (Line 1 minus Line 3)
5. Tax due (6% of Line 4)
6. Seller's Discount(Line 5 Multiplied by 3% if Recd by 20th)
7.Net Tax Due
8. Penalty(see Schedule Below)
9. Interest(.83% per month, 10% Annually)
10. TOTAL DUE (Sum of Lines 7,8,9)
IF THIS RETURN INCLUDES A FESTIVAL OR SPECIAL EVENT PLEASE LIST:
EVENT NAME: _______________________________
DATE(S) OF EVENT: ________________________________
This return is due on or before the 20th of each month to take the discount, and by the last day of the month to avoid penalties,
following the month in which the tax on Food and Beverage is made.
In accordance with City Ordinance Chapter 27(a) Article IV . Section 82-146 Penalties will be applied as follows:
* 1 to 30 days delinquent: an additional 10% of total tax due.
* 31 to 60 days delinquent: an additional 5% of total tax due.
* 61 to 90 days delinquent: an additional 5% of total tax due.
* 91+ days delinquent: an additional 5% of total tax due.
Interest will accrue at a rate of 10% per year on all delinquent account balances
Under penalties provided by law, the undersigned certifies that this return is true and accurate to the best of his/her knowledge
and belief and is taken from the books and records of the business for which this return is filed.
Signature ___________________________________ Date _________________________
Title_________________________________________Phone # ______________________
For Office Use Only
Received
Please make all checks payable to the City of Salem, Treasurer.
Remit to Commissioner of the Revenue, PO Box 869, Salem VA 24153
Payment Amount
Other

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