Utility Users Tax Remittance Form - City Of Alameda
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1
2CITY OF ALAMEDA
UTILITY USERS TAX REMITTANCE FORM
Company Name:
_________________________________________
Company Address:
_________________________________________
_________________________________________
Company Phone No.: _____________________
Company FEIN No.: ___________________
Tax Period Covered : _____________________
Type of Utility Service*: __________________
*Please submit separate remittance forms for each category of utility service that you provide, such as wired or
wireless telecommunications, electric, gas and cable television. If more than one category of utility services is
bundled together and billed as a single amount, please specify which utility services are bundled. The
information that you provide in this remittance form will be maintained as confidential under California Revenue
and Taxation Code Section 7284.6.
Remittance Based Upon Utility Billing
1.
Gross charges (including taxes and surcharges)
$____________________
2.
Deductions
a.
Taxes (federal, state, 911 tax)
$____________________
b.
Sales for Resale
$____________________
c.
Exempt Accounts
$____________________
d.
Other non-taxed charges**
$____________________
3.
Adjustments** (plus or minus)
$____________________
4.
Net taxable charges (line 1 minus lines 2+3)
$____________________
5.
Local Tax Due (@ 7.5% of line 4)
$____________________
6.
Penalties/Interest***
$____________________
7.
Total local tax due (sum lines 5 and 6)
$____________________
**Please attach a description of any adjustments or services not subject to the local tax referred to on lines 2d and 3.
***A 10% penalty and 1.5% monthly interest may apply if payment is not received by the City within the month that
follows the month in which you receive the utility users tax from the customer.
MAKE CHECK PAYABLE TO: CITY OF ALAMEDA
MAIL TO :
CITY OF ALAMEDA
ATTN: FINANCE DEPARTMENT
2263 SANTA CLARA AVENUE
ALAMEDA, CA 94501
I declare, under penalty of perjury, that to the best of my knowledge and belief the statements herein, and any
attachments hereto, are true and correct.
Date:
___
Signed:
________________
_______________________________________________________
Phone:
Print Name/Title : ________________________________________
__________________________
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