Form 200 - Virginia Litter Tax Return - 2003 printable pdf download

Form 200 - Virginia Litter Tax Return - 2003

FORM 200

VIRGINIA LITTER TAX RETURN

FOR CALENDAR YEAR

(DOC ID 200)

FILE THIS RETURN BY MIDNIGHT MAY 1

IF YOU ARE NOT IN BUSINESS ON JANUARY 1, YOU ARE NOT LIABLE FOR VIRGINIA

LITTER TAX UNTIL THE NEXT SUCCEEDING CALENDAR YEAR. IF YOU ARE LIABLE FOR

VIRGINIA LITTER TAX ON MORE THAN ONE VIRGINIA BUSINESS ESTABLISHMENT,

PLEASE ATTACH A LIST TO INCLUDE THE NAME, ADDRESS AND ACCOUNT NUMBER OF

EACH ESTABLISHMENT.

OUT OF BUSINESS - indicate the date

your business was terminated or sold.

1. ANNUAL $10.00 TAX

NO. OF VIRGINIA BUSINESS ESTABLISHMENTS . . . . . . . . . . . . . . . . .

VIRGINIA ACCOUNT NUMBER

FEDERAL EMPLOYER IDENTIFICATION NUMBER

OR SOCIAL SECURITY NO.

$10 =

2. ADDITIONAL ANNUAL $15.00 TAX

NO. OF VIRGINIA BUSINESS ESTABLISHMENTS . . . . . . . . . . . . . . . . .

$15 =

3. TOTAL (add lines 1 and 2) . . . . . . . . . .

4. PENALTY (see instructions) . . . . . . . . .

5. INTEREST (see instructions) . . . . . . . .

6. BALANCE DUE (add lines 3-5) . . . . . .

I declare this return (including any accompanying schedules and statements) has been examined by

me and to the best of my knowledge and belief is a true, correct and complete return.

MAKE CHECK PAYABLE TO THE VIRGINIA DEPARTMENT OF TAXATION

SIGNATURE ______________________________________________________________

(

)

DATE ________________________ TELEPHONE NO. ____________________________

Official form is smaller than full page. Please cut to size along dark lines before filing.

Filing a form the wrong size may result in rejection of the form,

and the state returning the form to you.

Form 200 - Virginia Litter Tax Return - 2003