Monthly Utility Tax Computation Form - County Of Henrico

Monthly Utility Tax Computation Form - County Of Henrico - 2002

COUNTY OF HENRICO

MONTHLY UTILITY TAX COMPUTATION FORM

COLLECTIONS FOR THE MONTH OF : ____________________

DUE DATE: ON OR BEFORE______________________________

Make checks payable and mail to:

Account Name:

County of Henrico

Department of Finance

P.O. Box 27032

Richmond, VA 23273

Attn: Business Section

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FILL IN THE INFORMATION BELOW TO REPORT AND COMPUTE YOUR TAX

ON ENHANCED EMERGENCY TELEPHONE SERVICE (E-911 system):

Tax in the Amount of $1.00 per Line

per Month

1._________________________

Less Tax Uncollectable

2._________________________

(Tax Uncollectable is tax due the service

provider which the consumer has refused to pay)

Plus Recovery of Outstanding Taxes 3._________________________

(Recovery of Outstanding Tax is uncollectable

tax collected)

Subtotal of Tax

4._________________________

(Line 1 - Line 2 + Line 3)

Less Discount for Collection of

Taxes

5._________________________

(Line 4 multiplied by 3%)

Total Tax To Be Remitted

6._________________________

(Line 4 - Line 5)

I CERTIFY (OR DECLARE) UNDER THE PENALTY OF PERJURY THAT THE

FOREGOING STATEMENTS ARE TRUE AND CORRECT.

SIGNATURE___________________________ DATE ____________________

TITLE________________________________ PHONE____________________

Monthly Utility Tax Computation Form - County Of Henrico - 2002