Yearly Gross Receipts Tax Form April 2006
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1SPOTSYLVANIA COUNTY
YEARLY GROSS RECEIPTS TAX
Commissioner of Revenue
9104 Courthouse Rd
Account # ____________
PO Box 175
Spotsylvania VA 22553- 0175
Phone: (540) 507-7054
Fax: (540) 582-7190
email: cor@spotsylvania.va.us
INSTRUCTIONS
Complete Sections A, B & C.
st
st
st
File on or before June 1
. In person – Deliver to our office by 4:30 on June 1
. By mail - Postmark on or before June 1
.
Make check payable to Treasurer, Spotsylvania County
Mail to: Deborah F Williams, Commissioner of Revenue, PO Box 175, Spotsylvania VA 22553-0175
A. Owner & Business Information
Owner’s Name
Phone
Mailing Address:
Block / Street Name
City
State
Zip
Trade Name
Phone
Physical Address:
Block / Street Name (No PO Boxes)
City
State
Zip
Social Security #
Federal ID
Email Address
B. Calculating Tax
to
2005
March
2005
December
1.
Total Gross Receipts for Period
$
Beginning
Ending
2.
Less Allowable Deductions (Attach List of Items/Explanation). If Zero, enter “0.”
$
3.
Total Taxable Gross (Subtract Line 2 from Line 1)
$
4.
One half of 1% (Multiply line 3 by 1%, then multiply by .5)
$
st
- Due by June 1
.
Penalty & Interest
- Late payment penalty is 10% of the tax and interest is 10% per year.
5.
$
* Interest will accrue at
a rate of 10% per year.
- If payment is past the due date, please call the Treasurer’s Office for penalty and
interest amount. (540) 507-7058 Monday -Friday from 8:00 am to 4:30 pm (EST)
6.
Total Tax and Penalty (Remember to include penalty from Line 5 if late.)
$
0.00
C. Declaration
I declare that the foregoing statement and figures are true, full, and correct to best of my knowledge and belief.
_______________________________
__________________
Signature of Owner or Agent
Date
_______________________________
__________________
Title
Phone
OFFICE USE ONLY
110-0000-312-04-01
Date: ____ /____ /____
Check # ___________
Late Payment Penalty
Reviewed by: ________
Amt $ ____________
Tax Difference $____________
(online form - rev 4/06)
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