Utility Users Tax Remittance Form - City Of Huntington Beach
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1
2CITY OF HUNTINGTON BEACH
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, gas, cable television and water services. 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 10% penalty shall apply if payment is not received by the City within the first twenty days of the month that follows the
month in which you receive the utility users tax from the customer.
MAKE CHECK PAYABLE TO: CITY OF HUNTINGTON BEACH
MAIL TO :
CITY OF HUNTINGTON BEACH
ATTN: FINANCE DEPARTMENT
2000 MAIN STREET
HUNTINGTON BEACH, CA 92648
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:
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