Utility Users Tax Return Form - City Of Oakland

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CITY OF OAKLAND
UTILITY USERS TAX RETURN
SERVICE SUPPLIER: __________________________
_________________________
Address:
_________________________
_________________________
Contact Person:
_________________________
Phone number:
___________________________
FOR THE PERIOD:
____________________________
1. GROSS COLLECTIONS
$_____________________
2. LESS EXEMPTIONS
_____________________
3. TAXABLE COLLECTIONS
$_______________________
4. TAX @ 7.5% OF LINE 3. (Line 3 x .075)
$_______________________
5. ADJUSTMENTS (Please itemize and explain)
$_______________________
6. ADJUSTED TAX DUE (combine lines 4 & 5)
$_______________________
7. PENALTY (For delinquent returns enter 25% of line 6)
$_______________________
8. SUBTOTAL (Sum of lines 6 & 7)
$_______________________
9. INTEREST (For delinquent returns add interest
$_______________________
@ 1% per month or part month)
$
10. TOTAL REMITTANCE (Sum of lines 8 & 9)
__________________________
Pursuant to Chapter 5, Article 23, Section 5-23.09 of the Oakland Municipal Code, every service supplier shall on or before the
45th day after the close of the billing cycle that ends on the last business day of any given month file return and remit the full
amount of the taxes collected to the City of Oakland. Please make your check payable to the CITY OF OAKLAND and remit
City of Oakland, File Number 73144
with return to:
PO Box 60000
San Francisco, CA 94160-3144
Signed____________________________Title_____________________Date______________
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.
.
Revised April 4, 2003

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