Utility Users Tax Statement Form - 2002 printable pdf download

Utility Users Tax Statement Form - 2002

& T

FFICE OF THE

REASURER

OLLECTOR

ITY AND

OUNTY OF

RANCISCO

Street Address: 1 Dr. Carlton B. Goodlett Place, Room 140, San Francisco, CA 94102

Mailing Address: P.O. Box 7425, San Francisco, CA 94120-7425

Taxpayer Services: (415) 554-4400

SUSAN LEAL

GEORGE PUTRIS

Treasurer

Tax Administrator

UTILITY USERS TAX STATEMENT

TELEPHONE, GAS, ELECTRICITY, & WATER

Ownership Name:

Federal ID #:

D B A:

Bus Tax Cert #:

Care of:

Period Covered:

Mailing Address:

Delinquent Date:

City, State, and Zip:

1. Enter taxable charges for period:

2. Tax due 7.5% of line 1 above:

3. Add: 5% Mo. Delinquency Penalty, up to 20% if delinquent:

4. Add: Interest @ 1% per month of line 2 above, if delinquent:

5. Adjustment, if any:

6. Payment enclosed:

Make check payable to the San Francisco Tax Collector and mail to:

CITY AND COUNTY TAX COLLECTOR

BUSINESS TAX DIVISION

PO BOX 7425

SAN FRANCISCO CA 94120-7425

I declare under penalty of perjury that I have examined this statement and that the information

contained herein is true and complete to the best of my knowledge and belief.

Signature

Date

(

)

Print Name

Business Telephone Number

(

)

Fax Number

Rev. 04/02

Utility Tax Form/

Utility Users Tax Statement Form - 2002

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