City Of Glendale 950 South Birch Street Occupational Privilege Tax Return Form
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1
2CITY OF GLENDALE
Tax Department
OCCUPATIONAL PRIVILEGE TAX RETURN
950 South Birch Street
Glendale, CO 80246
(303) 759-1513
YOU MUST FILE A RETURN EVEN IF YOU HAVE DETERMINED THAT NO TAX IS DUE
INSTRUCTIONS
LINE A
This line should include all employees that receive gross compensation of $750 or more in a month and work all or part of their time within
Glendale. Employees that have furnished a form verifying another employer is withholding, would be excluded from this total.
LINE B
This line should include all employees that receive gross compensation of $750 or more in a month and work all or part of their time within
Glendale. This figure should include all employees even though the employee may have another employer that is withholding. Self-employed
individuals, owners, partners and officers who are not paid a salary or commission are subject to only the employer portion of the tax, and
must be included in this line.
LINE C
This line is a total of the employees on line A and line B multiplied by the tax rate of $5.00 per month.
LINE D
Include Penalty of 10% if return is not filed by due date indicated on this form.
LINE E
Include Interest of 1% for each month the return is filed after the due date. Any portion of a month counts as a whole month.
LINE F
Credits: Include a full explanation of reason for the credit claimed. Attach appropriate documentation with all details.
LINE G
City Issued Adjustment from previous period: If an amount shows up on this line, add if balance due, deduct if credit.
LINE H
This line is a total of lines C + D + E - F +/- G. If you file a tax return showing “NO TAX LIABILITY”, please include a full explanation.
Account Number
Period Covered
Due Date
Line
DESCRIPTION
A
Number of Employees from whom tax was withheld:
B
Number of Employees for whom business must match:
TAX RATE
GRAND TOTAL
C
Total (A + B = C)
X $ 5.00
$
C
D
Late Filing Penalty: Line C x 10%
+
$
D
E
Late Filing Interest: Line C x 1% per each month delinquent
+
$
E
F
Less Credit (Documentation must be attached)
-
$
F
G
Balance From Previous Period
+ or -
$
G
H
$
H
Total Due: (Add C + D + E - F +/- G)
CHECK BOXES AND COMPLETE INFORMATION AS APPROPRIATE
_______________________________________
MAILING ADDRESS CHANGE
FINAL RETURN - CANCEL ACCOUNT
□
□
_______________________________________
(For Sales Tax Returns)
OUT OF BUSINESS DATE____________________
_______________________________________
_______________________________________
CHANGE OF OWNERSHIP DATE______________
MAILING ADDRESS CHANGE
□
□
_______________________________________
New Owner________________________________
(For OPT Returns)
_______________________________________
New Address (Use space at left)
_______________________________________
LOCATION ADDRESS
□
□
_______________________________________
PHONE CHANGE (______) ___________________
CHANGE
_______________________________________
MAKE A COPY OF THIS RETURN FOR YOUR RECORDS, AND MAIL ORIGINAL WITH THE PROPER PAYMENT TO THE CITY OF GLENDALE
I, hereby certify, under penalty of perjury, that the statements
made herein are to the best of my knowledge true and correct.
BY: ______________________________________________
TITLE: ___________________________________________
DATE: ___________________________________________
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