Fillable 2009 Long Form - Payroll Expense Tax Statement printable pdf download

PAYROLL EXPENSE TAX STATEMENT

2009

SAN FRANCISCO TAX COLLECTOR

DELINQUENT AFTER

LONG

BUSINESS TAX SECTION

FEBRUARY 28, 2010

P.O. BOX 7425

FORM

SAN FRANCISCO, CA 94120-7425

TAXPAYER ASSISTANCE: (415) 554-4400,

CERTIFICATE NUMBER

TAX YEAR

2009

DO NOT WRITE IN PRE-PRINTED AREAS. USE BLACK INK AND STAY INSIDE BOXES.

Final Statement:

Date ceased in SF or sold (mm/dd/yyyy)

If sold, name, address, and phone number of new owner:

____________________________________

(_______)____________________________

Contact Number

Complete this form if your 2009 taxable SF payroll expense was $66,666.34 or more, or you are claiming the Enterprise Zone tax credit.

Note: If the due date falls on a weekend or legal holiday, the deadline to file and/or pay without incurring penalties, interest, and an administrative fee is the close of business on

the next business day.

Total gross PAYROLL EXPENSE

From Schedule C,

line 8, column A

for the entire business entity

Total exempt PAYROLL EXPENSE

From Schedule C,

line 8, column B

Total Taxable S.F. Payroll Expense

From Schedule C,

line 8, column C

(Subtract line 2 from line 1)

Payroll Expense Tax Calculated (Multiply line 3 by 1.5% or .015)

NOTE: If line 4 is less than $1,000.00, complete and return the Registration Renewal only.

If line 4 is over $3,750.00 enter the amount from line 4. Otherwise, enter zero. (See C. on reverse side.)

Enter calculated Enterprise Zone Tax Credit AMOUNT and ATTACH WORKSHEET.

If none, enter zero on line 7.

Tax Liability after EZ Tax Credit (Subtract TOTAL of line 7 from line 6. If line 7 is greater than line 6, enter zero.)

2009 PREPAYMENT PAID (Do not include Registration Fees). If none, enter zero.

Tax due.

10.

(Subtract line 9 from line 8. If line 9 is larger than line 8, enter zero.)

Amount of overpayment. (If line 9 is larger than line 8, enter difference.) (See H. on reverse side.)

11.

If filed or postmarked after February 28, 2010, enter LATE FILING PENALTY. (See Table on reverse side.)

12.

If paid after February 28, 2010, enter LATE PAYMENT PENALTY. If Line 4 is greater than $3,750.00, add

13.

an additional 20% penalty after 5/31/10. (See Table on reverse side.)

14.

If paid after February 28, 2010, enter INTEREST base on line 10. (See Table on reverse side.)

If filed or postmarked after February 28, 2010, enter ADMINISTRATIVE FEE of $55.00.

15.

16.

TOTAL DUE. (Add Lines 10,12,13,14,15.) Make check payable to SF Tax Collector.

THIS STATEMENT MUST BE FILED OR POSTMARKED BY USPS BY FEBRUARY 28, 2010 OR YOU WILL BE SUBJECT TO FEES, PENALTIES, AND/OR INTEREST.

I hereby certify under penalty of perjury that I am the authorized representative of this taxpayer and I have examined the foregoing payroll expense tax

statement including any accompanying schedules and worksheets, and the information thereon is to the best of my knowledge and belief, true, correct,

and fully compliant with all of the requirements provided in Articles 6, 12 and 12-A of the San Francisco Business and Tax Regulations Code. I am

required by law to complete this form in its entirety and understand this statement is subject to audit.

PRINT NAME

TITLE

FAX NUMBER

SIGN HERE

DATE

B106-09

Prepare only one STATEMENT (Long Form) even if you attach multiple Schedule Cs

45488

PLEASE ATTACH SCHEDULE C TO STATEMENT WHEN FILING