Business Name:
FINANCE AND ADMINISTRATIVE SERVICES DEPARTMENT
Account Number:
REVENUE AND BUDGET DIVISION
Report Period Ending Date:
CITY OF ENGLEWOOD
01/20/1900
Date Due:
Today's Date:________________
01/03/2014
1000 ENGLEWOOD PARKWAY
ENGLEWOOD, CO 80110-2373
SECTION I: Sales, Lodger's and Use Tax Return
EMC 4-4-4 and 4-4-5
Sales and Use Tax
303-762-2422
Need assistance or have questions, please call
or refer to the
1
Gross Sales & Service
Guide
on the City's website
2A Add: Bad Debts Collected
2B Total 1 + 2A
3
A. Non-taxable Service
Filing Frequency Determination
Monthly - Sales and Use Tax remittance is at least $100 per month
B. Sales for Resale
Quarterly - Sales and Use Tax remittance is $50-99 per month
D
C. Shipped Out of City
Annually - Sales and Use Tax remittance is less than $50 per month
E
D. Bad Debts
D
E. Trade-ins for Resale
SECTION II: Basic Local Exchange Services Business and Occupation Tax EMC 4-5-3
U
F. Gas & Cigarettes
C
1 Total Number of Phone Lines
G. Government, Religious, Charitable
$
0.55
T
H. Returned Goods
2 Rate per Line
0.00
I
I. Presriptions
3 Total Line 1 X Line 2
10% (.10)
0.00
O
J.
4 Penalty
if filed late
1% (.01)
0.00
N
5 Interest
per month or part thereof if filed late
K. Groceries
0.00
S
6 SECTION II: TOTAL DUE
L.
M.
SECTION III: Waste Transfer Surcharge EMC 4-7-3
Total Deductions
4
Net Taxable
1 Total Cubic Yards
3.5% (.035)
$
0.50
0.00
5A City Sales Tax
of Line 4
2 Rate per Cubic Yard
(2% or .02)
0.00
0.00
5B Lodgers Tax Gross Rental
3 Total Line 1 X Line 2
10% (.10)
0.00
6
4 Penalty
if filed late
Add Excess Tax Collected
1% (.01)
0.00
0.00
7
Adjusted City Tax
5 Interest
per month or part thereof if filed late
0.00
8
6 SECTION III: TOTAL DUE
0.00
9
TOTAL SALES TAX
0.00
SECTION IV: Pawnbroker (EMC 5-15-4) AND Purchaser of Valuable Article (EMC 5-23-
10A Amount Subject to Use Tax
4) Transaction Fee
10B Additional Use Tax Due
0.00
11 TOTAL TAX DUE
Pawn
PoVA
Total
** If return is filed after the due date, penalty and interest is due **
1 Total Number of Transactions
10% (.10)
$
0.30
0.00
12A Penalty
2 Rate per Transaction
1% (.01)
0.00
0.00
12B Interest
per month or part thereof
3 Total Line 1 X Line 2
0.00
0.00
13 TOTAL TAX , PENALTY & INTEREST DUE
4 SECTION IV: TOTAL DUE
** Please use line 14A or 14B, if notified by the City **
SUMMARY OF TOTAL DUE AND PAYABLE TO THE
0.00
14 Add (Deduct) Per City Instruction
CITY OF ENGLEWOOD, COLORADO
0.00
15 SECTION I: TOTAL DUE
Business Address:
0.00
SECTION I: TOTAL DUE
0.00
SECTION II: TOTAL DUE
0.00
SECTION III: TOTAL DUE
0.00
SECTION IV: TOTAL DUE
0.00
Mailing Address:
TOTAL DUE AND PAYABLE
Please check here if changes to mailing or business address. Note
Signed:
changes in space provided above.
Business Closed
Date:_________________
Print:
Please make check payable and remit to:
Title:
CITY OF ENGLEWOOD
Phone:
PO BOX 2900
email:
ENGLEWOOD, CO 80150-2900
Date:
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