Monthly Sales Return Form - City Of Lakewood
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1City of Lakewood
Please mail this return along with
a check or money order to:
REVENUE DIVISION
REVENUE DIVISION
PO BOX 17479
PO BOX 17479
DENVER, CO 80217
DENVER, CO 80217
Tax Sales
Account
Letter
Period
City of Lakewood Monthly Sales Return
SCHEDULE A - SALES TAX
CHECK HERE IF THIS IS AN AMENDED RETURN
YOU MUST FILE A RETURN EVEN IF YOU
1
Gross Sales and Services (Total receipts from City activity must
HAVE DETERMINED THAT NO TAX IS DUE
00
be reported and accounted for on every return including sales,
ACCOUNT NUMBER
LICENSE #
rentals, leases, and all services both taxable and non-taxable)
Deductions included in line 1 above
2
TAX AREA
MEDIA #
SITE #
00
A.
Non-Taxable service sales
FILING PERIOD
DUE
00
B.
Sales to other licensed dealers for resale
LICENSE NAME & ADDRESS
00
C.
Sales of goods shipped or delivered outside of city
00
D.
Bad debts charged off
00
E.
Trade-ins for taxable resale
SCHEDULE B - PUBLIC IMPROVEMENT FEE
00
F.
Sales of gasoline and cigarettes
00
1
Gross sales and services
00
G.
Sales to governmental and charitable organizations
00
2
PIF Deductions
00
H.
Returned goods
00
3
Net PIF sales
00
I.
Prescription drugs
00
4
PIF Due (1.4% of Line 3)
00
J.
Other Non-taxable
00
5
Excess PIF collected
00
00
K.
Total deductions (Total of Lines 2A thru 2J)
6
Total PIF
3
00
00
Net taxable sales & services (Subtract Line 2K from Line 1)
7
Non-taxable PIF
4
00
00
Taxable PIF from Schedule B line 8
8
Taxable PIF (Line 6 minus Line 7)
5
00
ADDRESS CHANGE
Total net taxable amount (Add Line 3 & Line 4)
LICENSE
PRIMARY BUSINESS
MAILING
6
00
Amount of city sales tax (3% of amount on line 5)
LOCATION
LOCATION
7
00
STREET:
Add excess tax collected
CITY:
8
A.
Total purchase price of property subject to city
00
use tax. Please retain an itemized schedule of
STATE:
ZIP CODE:
City use tax
purchases for your records.
PHONE:
00
B.
Use tax (3% of amount on Line 8A)
FAX:
9
Total Taxes and Fees Due
00
(Add Lines 6, 7, 8B and Schedule B line 6)
EMAIL:
00
10
Late Filing -
A.
Penalty: 10% of Line 9
If the status of your business has changed, please complete the Account
if return is filed
Change or Closure Request Form located at our website:
after due date
00
B.
Interest: 1% of Line 9 for each month late
11
TOTAL DUE AND PAYABLE :
00
(Add lines 9, 10A, 10B)
Make payment payable to CITY OF LAKEWOOD
IMPORTANT:
I hereby certify, under penalty of perjury, that statements made herein are to the best of my knowledge true and correct.
Signature (Required)
Title
Date
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