Commissioner Of Revenue - Form printable pdf download

Commissioner Of Revenue - Form

INGRID H. MORROY

ARLINGTON, VIRGINIA

FRANK O'LEARY

COMMISSIONER

hone: 703-228-7180 Fax: 703-228-7048

TREASURER

OF REVENUE

SALES FOR:

Todays Date:

PAYMENT DUE:

ACCOUNT #

1. Gross Receipts Subject to Meals Tax

Amount Paid:

0.04

. Meals Tax Rate of 4%

3. Tax Amount: Multiply Line 1 by Line

Paid By:

4. A Late Penalty Applies After the 0th of the Month:

Multiply Line 3 by 10%, if applicable

CH CK

Check this box if any changes were

-CH CK

made to the information above.

5. Total Due: Add Line 3 and Line 4

Check this box and enter date

if you have sold/ceased business. You must still file this form either by mail or fax.

I hereby certify that the figures shown and reported on this form are true, correct, and complete.

Signed by Preparer

Print Name/ itle

elephone

INGRID H. MORROY

ARLINGTON, VIRGINIA

FRANK O'LEARY

COMMISSIONER

hone: 703-228-7180 Fax: 703-228-7048

TREASURER

OF REVENUE

SALES FOR:

Todays Date:

PAYMENT DUE:

ACCOUNT #

1. Gross Receipts Subject to Meals Tax

Amount Paid:

0.04

. Meals Tax Rate of 4%

3. Tax Amount: Multiply Line 1 by Line

Paid By:

4. A Late Penalty Applies After the 0th of the Month:

Multiply Line 3 by 10%, if applicable

CH CK

Check this box if any changes were

-CH CK

made to the information above.

5. Total Due: Add Line 3 and Line 4

Check this box and enter date

if you have sold/ceased business. You must still file this form either by mail or fax.

I hereby certify that the figures shown and reported on this form are true, correct, and complete.

Signed by Preparer

Print Name/ itle

elephone

INGRID H. MORROY

ARLINGTON, VIRGINIA

FRANK O'LEARY

COMMISSIONER

hone: 703-228-7180 Fax: 703-228-7048

TREASURER

OF REVENUE

SALES FOR:

Todays Date:

PAYMENT DUE:

ACCOUNT #

1. Gross Receipts Subject to Meals Tax

Amount Paid:

0.04

. Meals Tax Rate of 4%

3. Tax Amount: Multiply Line 1 by Line

Paid By:

4. A Late Penalty Applies After the 0th of the Month:

Multiply Line 3 by 10%, if applicable

CH CK

Check this box if any changes were

-CH CK

made to the information above.

5. Total Due: Add Line 3 and Line 4

Check this box and enter date

if you have sold/ceased business. You must still file this form either by mail or fax.

I hereby certify that the figures shown and reported on this form are true, correct, and complete.

Signed by Preparer

Print Name/ itle

elephone

Commissioner Of Revenue - Form

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