Sales/lodging/use/device Tax Return Form - City Of Black Hawk
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1PERIOD COVERED
CITY ACCOUNT #
DUE
STATE ACCOUNT #
CITY OF BLACK HAWK
COMPANY NAME & ADDRESS:
SALES/LODGING/USE/DEVICE
TAX RETURN
POST OFFICE BOX 68
BLACK HAWK, CO 80422
303-582-2283
5. CITY SALES TAX - 5.5% OF LINE 4
1. GROSS SALES AND SERVICE: TOTAL RECEIPTS FROM CITY ACTIVITIES MUST BE REPORTED AND
ACCOUNTED FOR IN EVERY RETURN INCL. ALL SALES, RENTALS AND LEASES AND ALL SERVICES BOTH
TAXABLE AND NON-TAXABLE.
6. LODGING TAX - FROM SCH D LINE 5:
X
0.25 %
2A ADD: BAD DEBTS COLLECTED
7. USE TAX - FROM SCH B
X
4.00 %
2B ADD: TOTAL LINES 1 & 2A
8. ADD: EXCESS TAX COLLECTED:
3
A. NON-TAXABLE SERVICE SALES (INCLUDED IN ITEM 1 ABOVE)
9. TOTAL TAX DUE: (ADD LINES 5, 6, 7 & 8)
B. SALES TO-OTHER LICENSED DEALERS " FOR PURPOSES OF
10. GENERAL DEVICE FEES
$62.50
X
TAXABLE RESALE
C. SALES SHIPPED OUT OF CITY AND OR STATE (INCLUDED IN ITEM 1
11. TRANSPORTATION DEVICE FEES
$6.42
X
ABOVE)
D.BAD DEBTS (ON WHICH CITY SALES TAX HAS BEEN PAID)
12. MAIN STREET BID DEVICE FEES
$7.42
X
E. TRADE-INS FOR TAXABLE RESALE
13. AMBULANCE DEVICE FEES
$2.50
X
D
E
F. SALES OF CIGARETTES
14. TOTAL DEVICE FEES DUE (ADD LINES 10, 11, 12 & 13)
D
U
G. SALES TO GOV'T, RELIGIOUS & CHARITABLE ORGANIZATIONS
15. TOTAL TAX DUE (ADD LINES 9 & 14)
C
T
H. RETURNED GOODS
16a. PENALTY 10% OF LINE 15 (Min $15)
I
O
I. PRESCRIPTION DRUGS/PROSTHETIC DEVICES
16b. INTEREST 1.5% OF LINE 15 (Per Month)
N
S
J. SALES OF RESIDENTIAL GAS & ELECTRICITY
17. TOTAL TAX PENALTY & INTEREST DUE: (ADD LINES 15, 16a AND 16b)
K. OTHER DEDUCTIONS (LIST)
18. ADJUSTMENTS - ATTACH SUPPORT - ADD (DEDUCT)
L.
19. TOTAL DUE AND PAYABLE TO THE CITY OF BLACK HAWK
SPECIAL MESSAGE TO AND FROM CITY/TAXPAYER
M.
3. TOTAL DEDUCTIONS (TOTAL OF LINES 3A THRU 3M)
4. TOTAL CITY NET TAXABLE SALES & SERVICE (LINE 2A MINUS LINE 3)
SCHEDULE B - CITY USE TAX
SCHEDULE C - CONSOLIDATED ACCOUNTS REPORT:
THIS SCHEDULE IS REQUIRED IN ALL CASES IN
The Municipal Code imposes a tax upon the privilege of using, storing, distributing or otherwise consuming in the City tangible property or
WHICH THE TAXPAYER MAKES A CONSOLIDATED RETURN WHICH INCLUDES SALES MADE AT MORE THAN ONE LOCATION. IT MUST BE
COMPLETELY FILLED OUT AND CONVEY ALL INFORMATION REQUESTED.
taxable services purchased, rented or leased.
DATE OF
NAME OF VENDOR
TYPE OF COMMODITY
PURCHASE PRICE
ACCOUNT
BUSINESS ADDRESSES
PERIODS TOTAL GROSS SALES
PERIODS NET TAXABLE SALES
PURCHASE
ADDRESS
PURCHASED
NUMBER
OF CONSOLIDATED ACCOUNTS
(AGGREGATE TO LINE 1)
(AGGREGATE TO LINE 4)
(A) LIST OF PURCHASES (IF ADDITIONAL SPACE NEEDED - ATTACH SCHEDULE IN SAME FORMAT)
$
$
(B) TOTAL PURCHASE PRICE OF PROPERTY SUBJECT TO USE TAX - ENTER ON LINE 7 ABOVE.
ENTER TOTALS HERE
ABOVE
$
$
SHOW CHANGE OF OWNERSHIP
SCHEDULE D - LODGING TAX
I hereby certify under penalty of perjury,
AND/OR ADDRESS, ETC.BELOW
D1. TOTAL LODGING SALES
Signature
D2. LODGING SALES TO GOV'T., RELIGIOUS & CHARITABLE ORGS.
Name
D3. LODGING PROVIDED ON COMPLIMENTARY BASIS
Telephone
D4. LODGING SALES OF 30 CONSECUTIVE DAYS OR MORE:
Date
D5. NET LODGING (D1 MINUS D2, D3 & D4) ENTER HERE & LINE 6 ABOVE
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