Transaction Privilege (Sales) Tax Return Form - City Of Flagstaff

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City of Flagstaff
City of Flagstaff - Sales Tax Division
BRE Insert
0.170000
2
11 West Aspen Ave.
Transaction Privilege (Sales) Tax Return
Flagstaff, AZ 86001
Phone: (928) 213-2250 Fax: (928) 213-2209
Account Name:
E-mail: SalesTax@flagstaffaz.gov
Account #
Report Period
Delinquency Date
0.170000
Return is due on the 20th of the month.
Delinquent if not paid by the last business day of the month.
--
Business Name
Return this form with your remittance to:
Attention
CITY OF FLAGSTAFF
PO BOX 22518
Mailing Address
FLAGSTAFF AZ 86002-2518
City/State/Zip
Place a check here and sign at the bottom if
®
you do not have taxes to report and remit.
Column 1
Column 2
Column 3
Column 4
Column 5
(From Schedule A)
=
=
Line
Tax Description
Tax Type
Gross Income
X Tax Rate
Taxable Income
Tax Due
Deductions
1
2
3
4
5
6
7
Subtotal (Add Column 5, lines 1 through 6)
8
Enter Total Excess City Tax Collected
Plus (+)
9
Total Tax Due (Add Column 5, lines 7 & 8)
Equals (=)
10
Penalty and Interest (See Instructions on Back of Form) or Outstanding Balance
Plus (+)
11
Enter Net Amount Due
Equals (=)
12
Enter Total Credit Balance to be Applied
Minus(-)
13
Enter Total Amount Paid
Equals (=)
Under penalty of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and
belief it is true, correct and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Taxpayer / Preparer Signature
Date
To cancel your license or to make any
®
changes to your account, check the box and
complete the back of this form.
Print Name
Phone #
A SIGNATURE IS REQUIRED TO MAKE THIS RETURN VALID
Return original with remittance to the address above.
Please make check payable to: CITY OF FLAGSTAFF
Please DO NOT mail cash.
* *
DPSYS_NEWPAGE
09/17/2012

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