Public Improvement Fee Schedule - Elk Valley Public Improvement Corporation

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PERIOD
DUE
MILLS PIF ACCT
CM
Elk Valley Public Improvement Corporation
--Select One--
--Select One--
COVERED
DATE
Public Improvement Fee Schedule
C/O CITY OF LAKEWOOD REVENUE DIVISION
TENANT’S NAME AND ADDRESS
P.O. BOX 280989
LAKEWOOD, CO 80228-0989
303.987.7683
COMPUTATION OF PIF
1. GROSS SALES AND SERVICE
0.00
2. LESS SALES/SERVICES NOT SUBJECT TO THE PUBLIC IMPROVEMENT FEE (RETAIN YOUR RECORDS FOR THREE YEARS)
0.00
3. NET SALES SUBJECT TO PUBLIC IMPROVEMENT FEE (LINE 1 MINUS LINE 2)
0.00
4. PUBLIC IMPROVEMENT FEE DUE (1.4% OF LINE 3)
0.00
5. EXCESS PUBLIC IMPROVEMENT FEE COLLECTED
0.00
6. TOTAL PUBLIC IMPROVEMENT FEE DUE (ADD LINES 4 AND 5)
0.00
7.
ADJUSTMENTS
ADD (ADDITIONAL AMOUNT DUE)
0.00
FOR PRIOR PERIOD
DEDUCT (CREDIT DUE TO MERCHANT)
0.00
8.
TOTAL PUBLIC IMPROVEMENT FEE DUE AND PAYABLE MAKE CHECK OR MONEY ORDER PAYABLE TO:
0.00
WELLS FARGO BANK WEST, N.A., AS TRUSTEE
COMMENTS
I HEREBY CERTIFY THAT THE STATEMENT MADE HEREIN IS
INDICATE ANY OWNERSHIP AND/OR ADDRESS CHANGES BELOW
TO THE BEST OF MY KNOWLEDGE TRUE AND CORRECT
AND CONFORMS TO TERMS ON MY LEASE
BY
PRINT NAME
TITLE
BUSINESS ADDRESS
MAILING ADDRESS
PHONE
E-MAIL
CLOSED BUSINESS ON _______/_______/_______
PERIOD
DUE
MILLS PIF ACCT
CM
--Select One--
--Select One--
Elk Valley Public Improvement Corporation
Public Improvement Fee Schedule
C/O CITY OF LAKEWOOD REVENUE DIVISION
TENANT’S NAME AND ADDRESS
P.O. BOX 280989
LAKEWOOD, CO 80228-0989
303.987.7683
COMPUTATION OF PIF
1. GROSS SALES AND SERVICE
0.00
2. LESS SALES/SERVICES NOT SUBJECT TO THE PUBLIC IMPROVEMENT FEE (RETAIN YOUR RECORDS FOR THREE YEARS)
0.00
3. NET SALES SUBJECT TO PUBLIC IMPROVEMENT FEE (LINE 1 MINUS LINE 2)
0.00
4. PUBLIC IMPROVEMENT FEE DUE (1.4% OF LINE 3)
0.00
5. EXCESS PUBLIC IMPROVEMENT FEE COLLECTED
0.00
6. TOTAL PUBLIC IMPROVEMENT FEE DUE (ADD LINES 4 AND 5)
0.00
7.
ADJUSTMENTS
ADD (ADDITIONAL AMOUNT DUE)
0.00
FOR PRIOR PERIOD
DEDUCT (CREDIT DUE TO MERCHANT)
0.00
8.
TOTAL PUBLIC IMPROVEMENT FEE DUE AND PAYABLE MAKE CHECK OR MONEY ORDER PAYABLE TO:
WELLS FARGO BANK WEST, N.A., AS TRUSTEE
0.00
COMMENTS
INDICATE ANY OWNERSHIP AND/OR ADDRESS CHANGES BELOW
I HEREBY CERTIFY THAT THE STATEMENT MADE HEREIN IS
TO THE BEST OF MY KNOWLEDGE TRUE AND CORRECT
AND CONFORMS TO TERMS ON MY LEASE
BY
PRINT NAME
TENANT COPY
TITLE
BUSINESS ADDRESS
MAILING ADDRESS
PHONE
E-MAIL
CLOSED BUSINESS ON _______/_______/_______

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