FOOD AND BEVERAGE TAX REPORT
CITY OF CHESAPEAKE, VIRGINIA
Return to: Ray A. Conner, Commissioner of the Revenue
PO Box 15285, Chesapeake, VA 23328-5285
(757) 382-6738 or 382-6739
ACCOUNT #:
For:
1. RECEIPTS SUBJECT TO TAX
2. TAX: 5.5% OF LINE 1
CERTIFIED SIGNATURE
DATE
3. PENALTY
4. INTEREST
(Applicant Name)
5. PRIOR BALANCE DUE
(Trade Name)
6. TOTAL TAX DUE
(Mailing Address)
(City, State, Zip)
RETURN DUE AND PAYABLE ON OR BEFORE 20TH DAY OF REPORTING MONTH
MAKE CHECKS PAYABLE TO CITY OF CHESAPEAKE (YOUR CHECK IS YOUR RECEIPT)
(Complete and return upper portion with payment)
RETAIN THE LOWER PORTION OF THIS WORKSHEET FOR YOUR RECORDS
1
GROSS SALES RECEIPTS
(TOTAL SALES FOR REPORTING MONTH)
2
DEDUCT NON PREPARED FOOD SALES
3
DEDUCT VIRGINIA STATE SALES TAX COLLECTED (5%)
4
DEDUCT CITY FOOD & BEVERAGE TAX COLLECTED (5.5%)
5
DEDUCT ANY EXEMPT SALES (CERTIFICATES ON FILE)
RECEIPTS SUBJECT TO CITY FOOD & BEVERAGE TAX
6
7
MULTIPLY LINE 6 BY .055 (5.5%) = Tax Amount Due
REMIT THIS AMOUNT
DATE __________________
CHECK NUMBER _______
Make Checks Payable to CITY OF CHESAPEAKE
If remitting late payment after the 20th of the month deadline :
8
Multiply the tax amount due (line 7) by .05 (5%) = Penalty
9
Add line 8 to line 7 and remit Total Payment
If the upper portion of this form shows a prior balance due, add that amount to your
check. If the prior balance due is a credit (-), deduct this amount from your check.
If you have any questions please contact:
Commissioner of the Revenue's Office
PO Box 15285, Chesapeake, VA 23328-5285
(757) 382-6738 or 382-6739
Fax: (757) 382-8822
E-Mail: bustax@comrev.city.chesapeake.va.us