Prepared Food & Beverage Tax Return Form - Mecklenburg County

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Account#:
City-County Tax Collector
Date Due:
Mecklenburg County
P.O. Box 32728
Charlotte, N.C. 28232
(704) 336-6315
FAX # (704) 336-7602
PREPARED FOOD & BEVERAGE TAX RETURN
(TO BE FILED WITHIN 15 DAYS FROM THE CLOSE OF EACH MONTH)
PLEASE READ CAREFULLY INSTRUCTIONS PRINTED ON BACK FOR COMPLETING THIS FORM
Return Period:
through
Account Number
Trade Name:
Mailing Address:
Social Security or Federal ID Number (optional)
(
)
-
Mailing City/State/Zip:
Business Phone Number
Street Address of Property:
Owner of Business – Name:
Address:
Phone Number:
COLUMN A
COLUMN B
SALES
TAX DUE
$
1. Gross Retail Receipts (Excluding Sales Tax)
$
2. Less: Non-Prepared Food/Beverage Receipts
$
3. Net Retail Receipts
4. Prepared Food/Beverage Tax Due:
$
(Multiply Amount on Line 3 by Tax Rate of 1%)
$
5. Excess Tax Collected
$
6. Penalty Due: (5% per month plus 10% – See Instructions on Back)
$
7. Interest (See Instructions on Back)
8. TOTAL TAX / PENALTY REMITTED
$
( Make Check Payable To City-County Tax Collector)
IF NAME, ADDRESS, LOCATION HAS CHANGED – OR IF THIS IS A FINAL RETURN –
PLEASE COMPLETE THE FOLLOWING:
Change of
Mailing
Location
Phone #
Trade
Ownership
Address
Address
Name
Was Business Sold?
Yes Date Sold: ____/____/____
Please cancel my account as of ____/____/____
Reason:
_
Reason must be indicated
(effective date)
_
CERTIFICATION. This is to certify that this return, including all statements and schedules attached hereto, has been examined by
me, and is, to the best of my knowledge and belief, a true and complete return made in good faith covering the month named above
and that same is in accordance with the records of the reporting taxpayer.
DATE
Name(please print)
Signature
_
THIS SPACE FOR TAX OFFICE USE ONLY
DATE RECEIVED
Return PM
AMOUNT REMITTED
Payment PM
RECEIVED BY

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