Form Mt-1 - Food & Beverage Tax Form - City Of Waynesboro Commissioner Of The Revenue

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CITY OF WAYNESBORO
FOOD & BEVERAGE TAX
COMMISSIONER OF THE REVENUE
503 W. MAIN ST., ROOM 107
WAYNESBORO, VIRGINIA 22980
___________________________________
NAME
___________________________________
TRADE NAME
___________________________________
________________________
P.O. BOX OR MAILING ADDRESS
MONTH/YEAR ENDED
___________________________________
________________________
CITY
STATE
ZIP CODE
DEFINITE LOCATION OF BUSINESS
1.
Gross receipts (month _________________)
$ ___________________ 1.
2.
Allowable deductions:
a. Meals to employees when no charge . . . . . . . . . . . . . $ _________________
is made to employee
b. Meals paid for by Federal, State or Local . . . . . . . . . . $__________________
Governments.
c. Meals or food sold from coin operated . . . . . . . . . . . . $__________________
vending machines
d. Other (please state) . . . . . . . . . . . . . . . . . . . . . . . . . . $__________________
e. Total Deductions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ___________________ 2.
3.
Item 1 less 2(e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________________3.
4.
Tax (6% of Item 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________________4.
5.
Seller’s discount (3% of item 4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________________5.
(Allowable only when return and payments are filed on time)
Total Tax less Seller’s Discount (item 4 less item 5) . . . . . . . . . . . . . . . . . . . . . . . $____________________6.
6.
Penalty for late payment – (5% of item 4 – minimum of $2.00) . . . . . . . . . . . . . . . $____________________7.
7.
8.
Interest (10% per Annum) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________________8.
9.
Total tax, penalty and interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $____________________9.
(sum of items 6, 7, and 8)
CHECK SHOULD BE MADE PAYABLE TO: CITY TREASURER, WAYNESBORO, VA
(Check must accompany this report)
NOTE:
PLEASE RETURN WITH CHECK ATTACHED TO:
Commissioner of the Revenue, 503 W. Main St., Room 107, Waynesboro, VA 22980
I declare that this return has been examined by me and to the best of my knowledge and belief it is a true, correct and complete
return.
Signature: ____________________________________________________________________
Date: ___________________
TH
NOTE: THIS REPORT MUST BE FILED BY THE 20
DAY OF THE MONTH FOLLOWING THE CALENDAR MONTH FOR
WHICH TAX IS DUE TO AVOID PENALTY AND INTEREST
Form MT-1

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