6,5% Food And Beverage Tax Report Form
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1CITY OF HAMPTON
THIS RETURN MUST BE FILED BY THE
ROSS A. MUGLER
TH
20
OF THE MONTH FOLLOWING THE
COMMISSIONER OF THE REVENUE
CALENDAR MONTH FOR WHICH TAX IS
CHECKS PAYABLE TO – TREASURER, CITY OF HAMPTON
DUE TO AVOID PENALTY.
(757) 727-6700
FOOD AND BEVERAGE TAX REPORT FOR MONTH OF _____________________
GROSS RECEIPTS
SUBJECT TO TAX
ACCOUNT #
TOTAL TAX @ 6.5%
NAME
PENALTY
ADDRESS
TOTAL TAX PAID
I HEREBY CERTIFY THAT THE FIGURES
SHOWN ON THIS FORM ARE CORRECT:
__________________________________________
CITY OF HAMPTON
THIS RETURN MUST BE FILED BY THE
ROSS A. MUGLER
TH
20
OF THE MONTH FOLLOWING THE
COMMISSIONER OF THE REVENUE
CALENDAR MONTH FOR WHICH TAX IS
CHECKS PAYABLE TO – TREASURER, CITY OF HAMPTON
DUE TO AVOID PENALTY.
(757) 727-6700
FOOD AND BEVERAGE TAX REPORT FOR MONTH OF _____________________
GROSS RECEIPTS
SUBJECT TO TAX
ACCOUNT #
TOTAL TAX @ 6.5%
NAME
PENALTY
ADDRESS
TOTAL TAX PAID
I HEREBY CERTIFY THAT THE FIGURES
SHOWN ON THIS FORM ARE CORRECT:
__________________________________________
DETACH AND RETURN TOP TWO COPIES TO THE COMMISSIONER OF THE REVENUE
CITY OF HAMPTON
THIS RETURN MUST BE FILED BY THE
ROSS A. MUGLER
TH
20
OF THE MONTH FOLLOWING THE
COMMISSIONER OF THE REVENUE
CALENDAR MONTH FOR WHICH TAX IS
CHECKS PAYABLE TO – TREASURER, CITY OF HAMPTON
DUE TO AVOID PENALTY.
(757) 727-6700
FOOD AND BEVERAGE TAX REPORT FOR MONTH OF _____________________
GROSS RECEIPTS
SUBJECT TO TAX
ACCOUNT #
TOTAL TAX @ 6.5%
NAME
PENALTY
ADDRESS
TOTAL TAX PAID
I HEREBY CERTIFY THAT THE FIGURES
SHOWN ON THIS FORM ARE CORRECT:
__________________________________________
TAXPAYER’S COPY
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