Special Tax Voucher Form - City Of Suffolk, Va

CITY OF SUFFOLK

SPECIAL TAX VOUCHER

6.5% Food/Beverage

8% Lodging/Hotel

10% Admissions

SUSAN L DRAPER

PAY BY ________________ TO AVOID PENALTY

COMMISSIONER OF THE REVENUE

PO BOX 1459

ACCOUNT #

SUFFOLK VA 23434

(757) 514-4261

TAX PERIOD

GROSS RECEIPTS

$

CITY TAX

$

NAME :

PENALTY

$

TRADE NAME :

ADDRESS :

TOTAL DUE

$

CHECKS PAYABLE TO TREASURER-CITY OF SUFFOLK

I d o s w e a r t h a t t h e f i g u r e s a r e t r u e t o t h e b e s t o f m y k n o w l e d g e . S I G N A T U R E : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D A T E _ _ _ _ _ _ _ _ _ _ _