Sales And Use Tax Return - City Of Lakewood
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1PHN 303-987-7630
CITY OF LAKEWOOD
SALES AND USE TAX RETURN
REVENUE DIVISION
TDD 303-987-7057
PO BOX 261450
FAX 303-987-7662
BELMAR
LAKEWOOD, CO 80226-9450
Revised 10-2008
*** PLEASE DO NOT STAPLE OR TAPE ANYTHING TO THIS FORM ***
TAXPAYER’S NAME AND ADDRESS
PERIOD:
--Select One--
DUE DATE:
--Select One--
LICENSE #:
(FROM LINE 3L)
1
GROSS SALES AND SERVICE
$0.00
5A
AMOUNT OF CITY SALES TAX
0.00
0.00
(Non-Grocery Items shipped out of Belmar)
$______________________ X 3%
2A
ADD: BAD DEBTS COLLECTED
0.00
5B
2B
TOTAL OF LINE 1 AND 2A
HOTEL/MOTEL ACCOMMODATIONS TAX:
$______________________ X 3%
0.00
0.00
3A
NON-TAXABLE SERVICE SALES
0.00
(FROM LINE 4)
5C
$0.00
AMOUNT OF CITY SALES TAX:
$________________________ X 1%
0.00
SALES TO OTHER LICENSED
3B
0.00
DEALERS FOR RESALE
5D
SALES SHIPPED OUT OF
3C
0.00
LAKEWOOD
3D
5E
BAD DEBTS CHARGED OFF
0.00
TRADE-INS FOR TAXABLE
3E
6
ADD: EXCESS TAX COLLECTED
0.00
0.00
RESALE
D
E
SALES OF GASOLINE AND
7
3F
TOTAL SALES TAX COLLECTED: ADD LINES 5A, 5B, 5C & LINE 6
0.00
0.00
CIGARETTES
D
8
U
SALES TO GOV’’T AND
3G
0.00
CHARITABLE ORG’S
9
C
T
CITY USE TAX (FROM SCHEDULE B)
3H
RETURNED GOODS
0.00
I
10
O
PURCHASES SUBJECT TO TAX:
$_______________________ X 3%
3I
PRESCRIPTION DRUGS
0.00
N
S
11
TOTAL TAX DUE ADD LINES 7 & 10
GROCERY FOOD SALES FOR
3J
0.00
HOME CONSUMPTION
0.00
IF FILED
10% PENALTY
AFTER
MULTIPLY PENALTY
PUBLIC IMPROVEMENT FEES
3K
12
THE DUE
& INTEREST
0.00
(NON-TAXABLE PURCHASES)
DATE
BY LINE 11
ADD:
1.2% INTEREST PER MONTH
SALES SHIPPED OUT OF BELMAR
3L
0.00
BUT WITHIN LAKEWOOD
TOTAL TAX, PENALTY, AND INTEREST DUE
13
0.00
ADD LINES 11 AND 12
3M
OTHER DEDUCTIONS
0.00
A. ADD: PRIOR PERIOD ADJUSTMENT
14
B. DEDUCT: PRIOR PERIOD ADJUSTMENT
3
TOTAL DEDUCTIONS OF LINES 3A through 3M
0.00
ADD LINES 13, 14A & 14B
MAKE CHECK OR
TOTAL DUE AND
TOTAL CITY NET TAXABLE SALES & SERVICE –
15
MONEY ORDER PAYABLE TO:
PAYABLE
4
SUBTRACT LINE 3 (TOTAL DEDUCTIONS) FROM LINE 2B
$0.00
CITY OF LAKEWOOD
SCHEDULE B – CITY USE TAX
The Lakewood Municipal Code imposes a tax upon the privilege of using, storing, or otherwise consuming tangible property or taxable services purchased, rented or leased in the City of Lakewood.
DATE OF PURCHASE
NAME OF VENDOR & ADDRESS
TYPE OF COMMODITY PURCHASED
PURCHASE PRICE
TOTAL PURCHASE PRICE OF PROPERTY/SERVICE SUBJECT TO CITY USE TAX, ENTER HERE AND ABOVE ON LINE 10
NOTES
NEW BUSINESS DATE
SHOW CHANGE OF OWNERSHIP, NAME AND/OR ADDRESS, ETC.
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE
STATEMENTS MADE HEREIN ARE, TO THE BEST OF MY
MO
DAY
YEAR
KNOWLEDGE, TRUE AND CORRECT.
1. If ownership has changed, give date of change
_______ BUSINESS ADDRESS
_______ MAILING ADDRESS
and new owner’s name.
SIGNED:
2. If business has been permanently terminated,
_______________________________________________________________________
give termination date.
PHONE:
TERMINATION DATE
3. If business location has changed give new
MO
DAY
YEAR
_______________________________________________________________________
address.
TITLE:
DATE:
_______________________________________________________________________
PRINT FORM
RESET FORM
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