City Of Lakewood Sales/use Tax Return Form
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1CITY OF LAKEWOOD SALES/USE TAX RETURN
PERIOD:
TAXPAYER’S NAME AND ADDRESS
DUE DATE:
ACCOUNT #:
1. GROSS SALES AND SERVICE
5A. AMOUNT OF CITY SALES TAX (LINE 4):____________________________ X 2%
2A. ADD: BAD DEBTS COLLECTED
5B. HOTEL/MOTEL ACCOMMODATIONS TAX: __________________________ X 3%
2B. TOTAL LINES 1 AND 2A
6. ADD: EXCESS TAX COLLECTED:
NON-TAXABLE SERVICE
A.
SALES
7. TOTAL SALES TAX COLLECTED: (ADD LINES 5A, 5B & LINE 6)
SALES TO OTHER LICENSED
B.
DEALERS FOR RESALE
8.
SALES SHIPPED OUT OF
C.
AREA
9.
CITY USE TAX (FROM SCHEDULE B)
D.
BAD DEBTS CHARGED OFF
TRADE-INS FOR TAXABLE
E.
RESALE
10. PURCHASES SUBJECT TO TAX: ___________________________________ x 2%
SALES OF GASOLINE AND
F.
CIGARETTES
11. TOTAL TAX DUE (ADD LINES 7 & 10)
SALES TO GOV’T, RELIGIOUS, AND
G.
IF FILING LATE
MULTIPLY PENALTY & INTEREST BY
CHARITABLE ORGANIZATIONS
10% PENALTY
AFTER DUE DATE
LINE 11
12.
H.
THEN ADD:
RETURNED GOODS
TOTAL TAX, PENALTY, AND INTEREST DUE
I.
PRESCRIPTION DRUGS
13.
(ADD LINES 11 AND 12)
PUBLIC IMPROVEMENT FEE NOT
J.
SUBJECT TO SALES TAX
A. ADD: (PRIOR PERIOD ADJUSTMENT)
14.
K.
OTHER DEDUCTIONS (LIST)
B. DEDUCT: (PRIOR PERIOD ADJUSTMENT)
L.
MAKE CHECK OR MONEY ORDER PAYABLE
TOTAL DUE AND
TO CITY OF LAKEWOOD
PAYABLE
(ADD LINES 13, 14A & 14B)
3.TOTAL DEDUCTIONS
(TOTAL OF LINES 3 A-L)
15.
AMOUNT PAID:
4. TOTAL CITY NET TAXABLE SALES & SERVICE (LINE 2B-3)
SCHEDULE A - SPECIAL MESSAGE FROM/TO CITY
SCHEDULE B-CITY USE TAX
SCHEDULE C-CONSOLIDATED ACCOUNTS
This schedule is required in all cases in which the taxpayer makes a consolidated return which includes sales made at
The Lakewood Municipal Code imposes a tax upon the privilege of using, storing or otherwise consuming
more than one location. It must be completely filled out and convey all information required in accordance with the
in the City tangible property or taxable services purchased, rented or leased.
column headings. If additional space is needed attach schedule in same format.
DATE OF PURCHASE
NAME OF VENDOR & ADDRESS
TYPE OF COMMODITY PURCHASED
PURCHASE PRICE
ACCOUNT NUMBER
BUSINESS ADDRESS
PERIOD’S TOTAL GROSS SALES
PERIOD’S NET TAXABLE SALES
LINE 1
LINE 4
TOTAL PURCHASE PRICE OF PROPERTY/SERVICE SUBJECT TO CITY USE TAX
ENTER TOTAL HERE AND ON THE RETURN ON LINE 1
ENTER TOTAL HERE AND ON THE RETURN
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE
NEW BUSINESS DATE:
CHANGE OF BUSINESS ADDRESS
STATEMENTS MADE HEREIN ARE, TO THE BEST OF MY KNOWLEDGE,
MONTH
DAY
YEAR
TRUE AND CORRECT.
CHANGE OF MAILING ADDRESS
X
SIGN
HERE
DISCONTINUED DATE:
PHONE
MONTH
DAY
YEAR
TITLE
DATE
PLEASE REMIT TO: CITY OF LAKEWOOD, P.O. BOX 261450, LAKEWOOD, CO 80226-9450
FOR QUESTIONS, PLEASE VISIT OUR WEBSITE AT OR CALL (303) 987-7630.
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