Form Gj410 - Annual Use Tax Return - City Of Grand Junction - 2001

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CITY OF GRAND JUNCTION
Accounting Division
250 North 5th Street, Grand Junction, CO 81501
(970) 244-1521 Fax (970) 256-4090
ANNUAL USE TAX RETURN FOR ________(YEAR)
T
/B
N
:
AXPAYER
USINESS
AME
P
S
A
:
HYSICAL
TREET
DDRESS
C
, S
, Z
:
ITY
TATE
IP
M
A
:
AILING
DDRESS
T
N
:
ELEPHONE
UMBER
Item or Group Description
Vendor Name & Location
Purchase Price
1.
$
2.
3.
4.
5.
If you need more space, please attach an extra sheet.
6.
Total Taxable Purchases
$
(Add line 1 through 5)
7.
City Use Tax Rate
X 2.75%
8.
Use Tax Due (If $50 or greater)
(Multiply line 6 by .0275)
$
I
8
$50
….complete and sign this return, and send it with payment to:
F LINE
IS
OR GREATER
City of Grand Junction – Sales Tax
250 N 5
S
,
TH
TREET
G
J
, CO 81501
RAND
UNCTION
Please make check payable to the “City of Grand Junction.”
T
J
20
. If not postmarked by that
HIS RETURN IS DUE BY
ANUARY
FOLLOWING THE YEAR YOU ARE FILING FOR
date, late penalties and interest may apply.
I hereby certify that I have examined this return and that it is to the best of my knowledge and belief a true and
complete return made in good faith for the period hereinabove stated:
Name (please print):
Title:
Signature:
Today’s Date:
If you have any questions, please direct them to Patricia Gillidette (970) 244-1598 or Jodi Romero (970) 244-
1520.
Thank you for your cooperation.
Form #GJ410 (7/01)

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