2009 Long Form - Payroll Expense Tax Statement Page 2
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1
2PAYROLL EXPENSE TAX STATEMENT
2009
LONG FORM
SAN FRANCISCO TAX COLLECTOR
BUSINESS TAX SECTION
SCHEDULE C
P.O. BOX 7425
SAN FRANCISCO, CA 94120-7425
TAXPAYER ASSISTANCE: (415) 554-4400,
CERTIFICATE NUMBER
TAX YEAR
2009
Column A
Column B
PAYROLL EXPENSE TAX CALCULATIONS
Column C
Taxable
Locations
No. of taxable SF
Payroll
NAICS Code
employees for
Gross Payroll Expense
Exempt Payroll Expense
(non-SF = 999)
Expense
2009
DBA Name and Location Address
DBA
1
.
.
LOC
DBA Name and Location Address
DBA
2
.
.
LOC
DBA Name and Location Address
DBA
3
.
.
LOC
DBA Name and Location Address
DBA
4
.
.
LOC
DBA Name and Location Address
5
DBA
.
.
LOC
DBA Name and Location Address
6
DBA
.
.
LOC
DBA Name and Location Address
7
DBA
.
.
LOC
8
Totals
PERIOD COVERED: January 1 - December 31, 2009 DELINQUENT AFTER FEBRUARY 28, 2010
36029
NOTE: Payment enclosed must equal the total due on Line 16 of statement.
(Please write your certificate number on your check.)
If you wish to designate 1% of your tax obligation to the SF Community Challenge Grant Program, fill in this
box. This will not increase your tax.
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