Meals Tax Monthly Report Form - Town Of Clarksville

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Meals Tax Monthly Report (type in fields, print & sign)
Business Name
Phone
Other Phone (cell)
Address
State
Zip
Reporting for Month of
1. Meal Charges Subject to Tax
2. Tax on Meals at 5% of #1
Please make checks payable to
3. Less 2% Discount Collection Fee**
Town of Clarksville
4. Total Tax Due #2 less #3
PO Box 1147
5. Penalty
Clarksville Virginia 23927
(Greater of: 10% of Tax Due or $10.00)
434-374-8177
(If not paid by the 20th)
Tax due by 20th of month following the month being reported.
6. Interest to Date (10% Per Annum)
**Collection Fee Only Applies if Tax is Paid by 20th of the Month.
7. Total Due if Paid After Due Date
Submitted by: __________________________________________________________________Date _____________________________

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