Financial Services Division Utility Users' Tax Remittance Form Claremont California
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1CITY OF CLAREMONT
FINANCIAL SERVICES DIVISION
UTILITY USERS’ TAX REMITTANCE
Month & Year of Utility Use __________________________
Business Name
____________________________________________
Business Location ____________________________________________
Telephone Number ____________________________________________
1)
Gross Service Charges (excluding tax)
________________
2)
Adjustments
________________
3)
Net Taxable Service Charges (line 1 minus line 2)
________________
4)
Calculation of Tax Due (5.5% of line 3)
________________
5)
Adjustments (plus or minus – attach itemized explanation)
________________
6)
Total Tax Due City
________________
The amount of tax collected one (1) month shall be remitted to the City on or before the
last day of the following month.
_______________________
________________________
________________
Signature
Printed Name & Title
Date
Please make check payable to the City of Claremont and mail to:
City of Claremont
Financial Services Department
P.O. Box 880
Claremont, CA 91711-0880
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