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 wired or
wireless telecommunications, electric or gas. If more than one category of utility services is bundled together and
billed as a single amount, please specify which utility services are bundled. The information that you provide in
this remittance form will be maintained as confidential under California Revenue and Taxation Code Section
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.
Penalties/Interest***
$____________________
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 and 1.5% monthly interest shall apply if payment is not received by the City within the month that
follows the month in which you receive the utility users tax from the customer. If payment is not received within two
(2) working days after the date of delinquency, a 20% penalty and 1.5% monthly interest shall apply.
MAKE CHECK PAYABLE TO: CITY OF CALABASAS
MAIL TO : CITY OF CALABASAS
ATTN: FINANCE DEPARTMENT
26135 MUREAU ROAD
CALABASAS, CA 91302-3172
I declare, under penalty of perjury, that to the best of my knowledge and belief the statements herein, and any
attachments hereto, are true and correct.
Date:
____
Signed:
_____________________
_______________________________________________________
Phone:
Print Name/Title : ________________________________________
__________________________
Please contact Steve Gibson of MBIA Muniservices Company at (800) 247-4406 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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