Local Sales Tax Return Form - City Of Bloomington - 2010
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12010 Local Sales Tax Return
These taxes are mandated by Bloomington City Code, Chapter 4
Checks payable to the “City of Bloomington. ” Mail two copies to the Accounting Division at the address below.
Payments can also be made by ACH. Please e-mail kcarlson@ci.bloomington.mn.us or call 952-563-8725 for instructions.
Establishment Name
(Not Corporate Name)
Mailing Address:
Street
Minnesota Sales Tax
Account Number (7 Digits)
City
State
Zip
Minnesota Sales Tax
Period End Date
Due Date
/
/
/
/
Your return must be postmarked by the 20th or received in our office by the 25th day of your City approved accounting period.
LIQUOR TAX
Office Use Only
1
LIQUOR TAX
Total Taxable Liquor Sales
2
Line 1 X 3%.
0.00
Liquor Tax Due
101-0000-212-24-02(06)
LODGING TAX
LODGING TAX
3
Gross Lodging Sales
101-0000-212-24-02(06)
4
Written leases for 30 days or more and
Less: Exclusions
101-0000-316-42-21(61)
other tax exempt lodgings per City Code.
5
Line 3 - Line 4.
0.00
Total Taxable Lodging Sales
770-0000-202-20-10(65)
6
Line 5 X 7%.
0.00
Lodging Tax Due
ADMISSION TAX
ADMISSION TAX
7
Total Taxable Admission Sales
8
Line 7 X 3%.
0.00
101-0000-316-42-01(62)
Admission Tax Due
TOTAL TAXES, PENALTIES AND INTEREST
Notes:
9
Line 2 + Line 6 + Line 8.
0.00
TOTAL LOCAL TAXES DUE
10
If payment is not made by date due, Line 9 X 5%.
5% Penalty
11
If payment is not made within 30 days after date due,
10% Penalty
(Line 9 + Line 10) X 10%.
If payment is not made by date due, (Line 9 + Line 10
PENALTIES AND INTEREST
12
6% Interest
÷
+ Line 11) X 6% X (Days past date due
360).
13
Line 10 + Line 11 + Line 12.
Total Penalties and Interest
0.00
101-0000-316-42-23
14
Line 9 + Line 13.
0.00
TOTAL AMOUNT DUE
I declare and certify under penalty of law that I have examined this statement and that to the
best of my knowledge and belief, it is true and complete.
Signature
________________________________________ Title (Print) ______________________________________
Name of Preparer (Print) __________________________________________ Date ____________________________
Phone ____________________________________________ E-mail __________________________________________
Finance Department
Accounting Division
PH
952-563-8725
E-MAIL kcarlson@ci.bloomington.mn.us
1800 W. Old Shakopee Road
FAX
952-563-8789
Bloomington MN 55431-3027
TTY
952-563-8740
33 _016 pg1 of 1 (11/09)
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