PAYROLL TAX STATEMENT
2004
SAN FRANCISCO TAX COLLECTOR
LONG
BUSINESS TAX SECTION
P.O. BOX 7425
FORM
DELINQUENT AFTER FEBRUARY 28, 2005
SAN FRANCISCO, CA 94120-7425
TAXPAYER ASSISTANCE: (415) 554-4400 TTY: (415) 554-4455
BUSINESS TAX ID NUMBER
CERTIFICATE NUMBER
TAX YEAR
2004
DO NOT WRITE IN PRE-PRINTED AREAS. USE BLACK INK AND STAY INSIDE BOXES.
PLEASE HAND PRINT. DO NOT TYPE. DO NOT SEND PHOTOCOPY.
Neighborhood Beautification Fund Designation
Final Statement: Date closed/sold
_________________
If sold, name, address, and phone number of new owner:
____________________________________
____________________________________
(_______)____________________________
Complete this form only if your 2004 taxable
San Francisco payroll was $66,666.67 or
more, or you are claiming a refund.
Otherwise, complete and return the
Business Registration Renewal only.
-
-
BUSINESS TELEPHONE NUMBER
,
.
,
,
$
1.
Total PAYROLL EXPENSE
From Schedule C,
line 8, column A
,
.
,
,
$
2.
From Schedule C,
line 8, column B
Total EXEMPT PAYROLL
3.
From Schedule C,
line 8, column C
Total Taxable S.F. Payroll (Subtract line 2 from line 1)
$
,
.
,
,
4.
Payroll Tax Calculated (Multiply line 3 by Payroll Tax rate of 1.5% or .015)
$
5.
If line 4 is less than $1,000.00.
Do not complete this form unless claiming a refund. Complete and return the Registration Renewal only.
6.
If line 4 is over $2,500.00 enter the amount from line 4, otherwise, enter
zero, and complete lines 7 to 14.
$
Enter calculated Enterprise Zone and/or G arment Mfrs. TA X CREDIT AMO UNTS and ATTACH WO RK SHEETS. If none, put zero on line 7 total.
7.
Enterprise Zone
Garment Mfrs.
,
.
,
,
ENTER TAX CRE DITS
$
,
,
,
.
$
$
TOTAL (EZ+GM):
$
8.
Tax Liability after EZ and/or GM Tax Credits
(Subtract TOTAL of line 7 from line 6. If line 7 is greater than line 6, enter zero.)
$
9.
Enter 2004 PREPAYMENT PAID (Do not include Registration Fees). If none, enter zero.
$
10.
Amount you owe. (Subtract line 9 from line 8. If line 9 is larger than line 8, enter zero.)
,
,
.
Amount to be refunded to you. (If line 9 is larger than line 8, enter difference.) See instructions.
$
11.
$
LATE FILING PENALTY. If filed or postmarked after February 28, 2005, enter penalty amount. See instructions.
12.
13.
$
LATE PAYMENT PENALTY. If paid after February 28, 2005, enter late payment penalty. See instructions.
$
14.
INTEREST. If paid after February 28, 2005, enter interest. See instructions.
ADMINISTRATIVE FEE. If filed or postmarked after February 28, 2005, enter fee of $35.00.
$
15.
16.
$
TOTAL AMOUNT YOU OWE.
(Add Lines 10,12,13,14,15.) M ake check payable to San Francisco Tax Collector.
THIS STATEMENT MUST BE FILED BY FEBRUARY 28, 2005 OR YOU WILL BE SUBJECT TO FEES, PENALTIES, AND/OR INTEREST.
Under the laws of the State of California, I declare under penalty of perjury that I have read the foregoing and that it is true, correct, and complete to the
best of my knowledge and belief.
X
SIGN HERE
DATE
B106-04
Prepare only one STATEMENT (Long Form) even if you attach multiple Schedule Cs
PLEASE ATTACH SCHEDULE C TO STATEMENT WHEN FILING
7180