Utility Users Tax Remittance Form - City Of El Monte
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1City of El Monte
UTILITY USERS TAX REMITTANCE FORM
Name of Utility Service Provider: ________________________________________________
Name of Billing Agent (if any): __________________________________________________
Type of Utility Service(s): ______________________________________________________
(Gas, electricity, wired or wireless telephone, private communication services, or bundles thereof)
Company FEIN No.: _________________________________________ Remitted by ACH __________
Tax Period Covered*: _________________________________________
The information that you provide in this remittance form will be maintained as confidential under Rev. and
Tax. Code § 7284.6.
Gross Charges:
$_____________________
Deductions:
$_____________________
[Taxes, Resale sales, Exempt
Accounts]
Non-standard Adjustments**: $_____________________
Net Taxable Charges:
$_____________________
Tax Percentage Applied:
______________%_____
•
Electricity-7%
•
Gas-7%
•
Telecom-6.5%
Penalties:
$_____________________
Interest:
$_____________________
Total Remittance:
$_____________________
Remit to:
ATTN: Finance Department
CITY OF EL MONTE
11333 Valley Blvd.
El Monte, CA 91731-3293
Please note that payment must be received by the City by no later than the twentieth day of the following
month (due date). Penalties (15%) and interest will be imposed on delinquent payments.
*Please prepare a separate remittance form for each tax period; do not combine tax periods.
**Please describe any non-standard adjustments:
________________________________
______________________________________________________________________________
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