Utility Users Tax Prepayment Form - City Of Modesto
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1CITY OF MODESTO
UTILITY USERS TAX PREPAYMENT FORM
Business: ___________________________________
Address: ___________________________________
City:
___________________________________
Our firm wishes to prepay the maximum Utility Users Tax for calendar year ________ in the
amount of $1,500 per individual utility account as follows:
Name of Utility
Account Number
Amount
____________________
__________________________
$____________
____________________
__________________________
____________
____________________
__________________________
____________
____________________
__________________________
____________
____________________
__________________________
____________
TOTAL (Check Enclosed)
$____________
Signature: __________________________
Title:
__________________________
Date: ____________
Telephone: _______________
Please reply by December 15th
Please make checks payable to:
City of Modesto
Finance Dept.
P.O. Box 642
Modesto, CA 95353
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