Sales And Use Tax Return Form - Revenue Division Of City Of Lakewood
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1CITY OF LAKEWOOD
PHN 303-987-7630
SALES AND USE TAX RETURN
TDD 303-987-7057
REVENUE DIVISION
COLORADO MILLS AND CREEKSIDE
FAX 303-987-7662
PO BOX 261450
LAKEWOOD, CO 80226-9450
PRINT FORM
CLEAR FORM
REVISED 11/09/05
***PLEASE DO NOT STAPLE OR TAPE ANYTHING TO THIS FORM***
TAXPAYER'S NAME AND ADDRESS
--Select One--
PERIOD:
--Select One--
DUE DATE:
LICENSE #:
(FROM LINE 3L)
GROSS SALES AND SERVICE
AMOUNT OF CITY SALES TAX :$_________________________ X3%
1
5A
(Non- Grocery items shipped out of PIF area but within Lakewood)
ADD: BAD DEBTS COLLECTED
HOTEL/MOTEL ACCOMMODATIONS TAX $________________ X 3%
2A
5B
(FROM LINE 3J)
TOTAL OF LINES 1 AND 2A
2B
5C
GROCERIES SUBJECT TO TAX:$_________________________ X2%
(FROM LINE 4)
NON-TAXABLE SERVICE SALES
3A
5D
AMOUNT OF CITY SALES TAX:$__________________________ X2%
SALES TO OTHER LICENSED
3B
6
ADD: EXCESS TAX COLLECTED:
DEALERS FOR RESALE
SALES SHIPPED OUT OF
TOTAL SALES TAX COLLECTED: ADD LINES 5A, 5B, 5C, 5D & LINE 6
3C
7
LAKEWOOD
3D
BAD DEBTS CHARGED OFF
8
9
TRADE-INS FOR TAXABLE
3E
RESALE
CITY USE TAX (FROM SCHEDULE B)
10
SALES OF GASOLINE AND
PURCHASES SUBJECT TO TAX: $_________________________ x 3%
3F
CIGARETTES
SALES TO GOV'T, RELIGIOUS, AND
TOTAL TAX DUE ADD LINES 7 & 10
3G
11
CHARITABLE ORGANIZATIONS
IF FILED
RETURNED GOODS
10% PENALTY
3H
MULTIPLY PENALTY &
AFTER THE
12
INTEREST BY
DUE DATE
LINE 11
ADD:
PRESCRIPTION DRUGS
INTEREST 1.4% PER MONTH
3I
TOTAL TAX, PENALTY, AND INTEREST DUE
GROCERY FOOD SALES
3J
13
ADD LINES 11 AND 12
PUBLIC IMPROVEMENT FEE
COLLECTED ON NON TAXABLE
3K
A. ADD: PRIOR PERIOD ADJUSTMENT
PURCHASES
14
ITEMS SHIPPED OUT OF PIF AREA
3L
BUT WITHIN LAKEWOOD
B. DEDUCT: PRIOR PERIOD ADJUSTMENT
OTHER DEDUCTIONS
3M
TOTAL DEDUCTIONS OF LINES 3A THROUGH 3M
ADD LINES 13, 14A & 14B
3
TOTAL DUE AND
MAKE CHECK OR MONEY ORDER PAYABLE
15
PAYABLE
TOTAL CITY NET TAXABLE SALES & SERVICE -
TO CITY OF LAKEWOOD
4
SUBTRACT LINE 3 (TOTAL DEDCUTIONS)FROM LINE 2B
SCHEDULE B - CITY USE TAX
The Lakewood Municipal Code imposes a tax upon the privilege of using, storing or otherwise consuming in the City tangible property or taxable services purchased, rented or leased.
DATE OF PURCHASE
NAME OF VENDOR & ADDRESS
TYPE OF COMMODITY PURCHASED
PURCHASE PRICE
LINE 10
TOTAL PURCHASE PRICE OF PROPERTY/SERVICE SUBJECT TO CITY USE TAX ENTER TOTAL HERE AND ABOVE ON LINE 10
NOTES
SHOW CHANGE OF OWNERSHIP, NAME AND/OR ADDRESS, ETC
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE
NEW BUSINESS DATE
STATEMENTS MADE HEREIN ARE TO THE BEST OF MY
1. If ownership has changed, give date of change
KNOWLEDGE, TRUE AND CORRECT.
MO
DATE
YEAR
BUSINESS ADDRESS
MAILING ADDRESS
and new owners name.
__________________________________
SIGN
2. If business has been permanently terminated,
give termination date.
__________________________________
TERMINATION DATE
COMPANY:
MO
DATE
YEAR
__________________________________
PHONE:
3. If business location has changed give new
address.
TITLE:
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