Utility Users Tax Remittance Form - City Of Calabasas
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1CITY OF CALABASAS
UTILITY USERS TAX REMITTANCE FORM
Company Name:
________________________________________________________________________________
Company Address:
________________________________________________________________________________
________________________________________________________________________________
Company Phone No.:
______________________________ Company FEIN No.: _____________________________
Tax Period Covered:
______________________________ Type of Utility Service:_____________________________
Please submit separate remittance forms for each category of utility service that you provide, such as electricity, gas, wireless, and wireline
telecommunications. If more than one category of utility services is bundled together and billed as single amount, then please note above each
category of utility service that is included. The information that you provide in this remittance form will be maintained as confidential under
Rev. and Tax Code § 7284.6.
Remittance Based Upon Utility Billing
1.
Gross charges (including taxes and surcharges)
$_____________________
2.
Deductions
a.
Taxes (federal, state, 911 tax)
$_____________________
b.
Sales for Resale
$_____________________
c.
Exempt Accounts
$_____________________
d.
Other non-taxed charges*
$_____________________
3.
Adjustments* (plus or minus)
$_____________________
4.
Net taxable charges (line 1 minus lines 2+3)
$_____________________
5.
Local Tax Due (5% of line 4)
$_____________________
6.
Interest/Penalties**
$_____________________
7.
Total local tax due (sum lines 5 and 6)
$_____________________
* Please attach a description of any adjustments or services not subject to the local tax referred to on lines 2d and 3.
** A 5% penalty (increasing to 20% if not received within two working days of date of delinquency) and 1.5% monthly interest
shall apply if payment is not received by the City on or before the last day of the month that follows the month in which you
receive the utility users tax from the customer.
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:
_____________________________________
Signed: ____________________________________________
Phone: _____________________________________
Print Name/Title:_____________________________________
MAKE CHECK PAYABLE TO:
CITY OF CALABASAS
MAIL TO:
FINANCE DEPARTMENT
100 CIVIC CENTER WAY
CALABASAS, CA 91302
Please contact City of calabasas' Planning department at (818) 224-1600 if you have any questions regarding the City boundaries
(by street address) or the application of the City’s local tax to the services that you provide your customers in the City.
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