Food And Beverage Tax Form - Virginia Commissioner Of The Revenue

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AMHERST COUNTY
Commissioner of the Revenue
Linda M. Byers
P.O. Box 719
AMHERST, VA. 24521
(434) 946-9310
FOOD AND BEVERAGE TAX
BUSINESS NAME: _______________________ CONTACT PERSON: _____________________
TRADING AS: ___________________________ TELEPHONE NUMBER: _________________
ADDRESS: ______________________________ MONTH/YEAR: _________________________
______________________________
FEDERAL ID NUMBER: _________________
1. GROSS SALES OF PREPARED FOOD AND BEVERAGES
$___________
2. ALLOWABLE DEDUCTIONS AS DEFINED IN AMHERST COUNTY
$(_________)
CODE SECTION 14-129
3. TAXABLE SALES (LINE 1 MINUS LINE 2)
$___________
4. TAX DUE (4% OF LINE 3)
$___________
TH
5. SELLERS DISCOUNT (3% OF LINE 4 IF REMITTED BY 20
)
$(_________)
6. ADJUSTMENTS FROM PREVIOUS MONTH
$___________
7. NET MEALS TAX DUE
$___________
8. 10% PENALTY FOR LATE PAYMENT
$___________
9. 10% INTEREST PER YEAR
$___________
10. TOTAL MEALS TAX, PENALTY AND INTEREST DUE
$___________
(SUM OF LINES 7, 8 AND 9)
TH
REPORT AND PAYMENT DUE ON OR BEFORE THE 20
DAY OF THE MONTH
FOLLOWING THE MONTH WHICH THE TAX WAS COLLECTED. CHECK OR MONEY
ORDER SHOULD BE MADE PAYABLE TO “TREASURER, AMHERST COUNTY” AND
MAILED TO THE COMMISSIONER OF THE REVENUE AT THE ADDRESS LISTED ABOVE.
UNDER PENALTIES PROVIDED BY LAW, THE UNDERSIGNED CERTIFIES THAT THIS
FORM IS TRUE AND ACCURATE TO THE BEST OF HIS/HER KNOWLEDGE AND
BELIEF AND IS TAKEN FROM THE BOOKS AND RECORDS OF THE BUSINESS FOR
WHICH THIS FORM IS FILED.
________________________________
________________________________
SIGNATURE
COMM. OF REVENUE
DATE
________________________________
________________________________
TITLE
DATE
TREASURER
DATE
PLEASE SIGN & RETURN COMPLETED TOP COPY TO INSURE PROPER CREDIT

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