Food And Beverage Tax Return Form - 2009

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FOOD AND BEVERAGE TAX RETURN
BUSINESS LICENSE
CITY OF JOLIET
STATEMENT OF TAX RECEIPTS UNDER THE PROVISIONS OF
150 WEST JEFFERSON STREET
ORDINANCE NO. 9166 and NO. 7650
JOLIET, ILLINOIS 60432
TELEPHONE: (815) 724-3905
TAX RETURN
FAX:
(815) 740-1221
FOR MONTH OF ________________________________________
UNDER
PENALTIES
PROVIDED
BY
ORDINANCE,
THE
UNDERSIGNED CERTIFIED THAT THIS RETURN IS TRUE AND
FINAL RETURN
ACCURATE AND IS TAKEN FROM THE BOOKS AND RECORDS
BUSINESS SOLD
OF THE BUSINESS FOR WHICH THE RETURN IS FILED.
BUSINESS DISCONTINUED ___________________
(DATE)
______________________________
___________________
IF BUSINESS HAS BEEN DISCONTINUED AND/OR NO LONGER
SIGNATURE
TITLE
INCURS LIABILITY FOR TAX, PLACE AN (X) IN THE BOX AND
ANSWER THE FOLLOWING:
______________________________
DATE
NEW OWNER’S NAME ________________________________
TAX COMPUTATION
NEW OWNER’S ADDRESS ____________________________
1)
TOTAL FOOD-BEVERAGE TAX COLLECTED
1) __________________
FORMER OWNER’S
2)
TOTAL GROSS RECEIPTS FROM THE
RESIDENCE ADDRESS _____________________________
TAXABLE PURCHASES OF FOOD & BEVERAGE
ITEMS, EXCLUSIVE OF ANY TAXES.
2) __________________
3)
COMPUTED FOOD & BEVERAGE TAX
3) __________________
(LINE 2 MULTIPLIED BY .0100 (1%)
STATE TAX NUMBER: ________________________________
4)
PENALITY OF 2% PER MONTH IF FILED LATE
4) __________________
NAME AND ADDRESS OF BUSINESS:
5)
TAX AMOUNT REMITTED
5) __________________
____________________________________________________
NOTE: ON LINE (5), REMIT LINE (1) OR LINE (3) WHICHEVER IS GREATER,
PLUS PENALTY IF APPLICABLE.
____________________________________________________
____________________________________________________
MY NAME IS (PRINT): ____________________________________
____________________________________________________
ADDRESS:______________________________________________
CITY: _____________________
STATE: __________________
MAKE CHECK PAYABLE TO: CITY COLLECTOR
ZIP CODE: _________________
MAIIL TO: CITY COLLECTOR
CITY OF JOLIET
_______________________________________________________
150 WEST JEFFERSON STREET
E-MAIL ADDRESS
JOLIET, ILLINOIS 60432
TO PAY BY VISA OR MASTERCARD, FILL OUT THE PORTION
Please check here if address, phone number, or e-mail
BELOW AND SIGN YOUR NAME:
changes are indicated above.
MASTERCARD
VISA
__ __ __ __
__ __ __ __
__ __ __ __
__ __ __ __
NUMBER:
EXPIRATION DATE __________/__________
SIGNATURE: ___________________________________________
Revised 06/2009

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