UF-1 2010
NON-RESIDENT SPORTS FACILITY
USAGE FEE
CFD
CITY OF PITTSBURGH
Rev 9/09
Amended Return ( )
Tax Return No Longer Needed ( )
CITY ID
FEDERAL ID
SIGNATURE _____________________________________________
FEE PERIOD
QUARTER
Due on or before
TITLE _____________________ DATE _______________________
PHONE _________________________________________________
E-MAIL ADDRESS ________________________________________
PREPARER’S NAME ______________________________________
PREPARER’S PHONE ______________________________________
I hereby certify, swear and aver that all statements herein are true and correct to the best of my knowledge and
belief, being duly apprised of my duty under the law to submit honest and complete information or be subject to the
penalties provided by law.
Make name/address corrections above
OMISSION OF THE ABOVE APPLICABLE INFORMATION
USE BLACK INK ONLY ON THIS FORM
CONSTITUTES AN INCOMPLETE RETURN
EVENT DATE(S): _______________________
EVENT FACILITY:___________________________
NUMBER OF EMPLOYEES FOR WHOM USAGE FEE IS BEING REMITTED: _____________________
ATTACH A LIST INCLUDING THE SOCIAL SECURITY NUMBER, NAME, ADDRESS, PITTSBURGH
INCOME AND THE AMOUNT WITHHELD FOR EACH EMPLOYEE.
.
1.
COMPENSATION ALLOCABLE TO PITTSBURGH
.
2.
ADJUSTMENTS – attach explanation
.
3.
COMPENSATION SUBJECT TO FEE – subtract Line 2 from Line 1
.
4.
AMOUNT DUE – multiply Line 3 by 3% - (.03)
.
5.
PENALTY – City penalty 1% per month or fraction thereof
.
6.
TOTAL DUE – add Lines 4 & 5
TOTAL REMITTANCE WITH THIS RETURN
.
Make check payable to: TREASURER, CITY OF PITTSBURGH – DO NOT SEND CASH
Mail to: USAGE FEE DUE – 414 GRANT ST RM 206 – PITTSBURGH PA 15219-2476
A $30.00 fee will be assessed for any check returned from the bank for any reason.
For assistance call 412-255-8919