Meals Tax Form - Charlottesville, Virginia
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1Commissioner of the Revenue
MEALS TAX
605 E Main Street, Room A-130
P.O. Box 2964
TAX YEAR
TAX MONTH
Charlottesville, VA 22902-2964
Phone: (434) 970-3170
TAX DUE ON OR BEFORE
Fax: (434) 970-3663
TO AVOID PENALTY & INTEREST, THIS RETURN MUST BE FILED AND PAID ON OR BEFORE THE DUE DATE.
BUSINESS INFORMATION
LICENSE NUMBER
LEGAL BUSINESS NAME
TRADE NAME
LOCATION ADDRESS
TAX ID
CITY
STATE
ZIP
Charlottesville
VA
CONTACT NAME
TITLE
PHONE
E-MAIL
MEALS TAX INFORMATION
$
01. GROSS RECEIPTS / SALES FOR MONTH ENDING.......................................................................
02. ALLOWABLE DEDUCTIONS
( click for FAQs )
$
a. Meals to employees, when no charge is made to employee..
$
b. Meals paid by federal, state, or local governments................
$
c. Meals or food sold from coin operated vending machines.....
$
d. Other __________________________________________
$
03. TOTAL DEDUCTIONS.......................................................................................................................
SUM OF LINES 2A, 2B, 2C, & 2D
$
04. NET GROSS RECEIPTS...................................................................................................................
LINE 1 ( - ) LINE 3
$
05. TAX....................................................................................................................................................
LINE 4 ( X ) 5%
$
06. DISCOUNT IF FILED AND PAID ON OR BEFORE...........................................................................
LINE 5 ( X ) 3%
$
07. TOTAL TAX DUE...............................................................................................................................
LINE 5 ( - ) LINE 6
$
08. PENALTY FOR LATE PAYMENT........................................................................................................
LINE 5 ( X ) 5%, MINIMUM $2.00
$
09. INTEREST..........................................................................................................................................
10% PER ANNUM
$
10. TOTAL TAX, PENALTY, & INTEREST..............................................................................................
SUM OF LINES 7, 8, & 9
DECLARATION
Pursuant to VA Code § 58.1-3906 Any corporate, partnership or limited liability company officer who willfully fails to pay, collect, or truthfully account for and pay over any local
admission, transient occupancy, food and beverage, or daily rental property tax administered by the commissioner of revenue or other authorized officer, or willfully attempts in
any manner to evade or defeat any such tax or the payment thereof, shall, in addition to other penalties provided by law, be liable for a penalty of the amount of the tax evaded
or not paid, collected, or accounted for and paid over, to be assessed and collected in the same manner as such taxes are assessed and collected.
I declare that the foregoing statement and figures are true, complete, and correct to the best of my knowledge and belief.
PREPARER
TITLE
PHONE
E-MAIL
CLEAR FORM
FOR OFFICE USE ONLY
AMOUNT
CK # / METHOD OF PAYMENT
LEGAL RECEIPT DATE
PAID DATE
PROCESSED BY
NOTE
Form revised 01/2017
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