Form 13 - Report Of Amusement Tax Collected

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Form 13 (12-80)
BOARD OF SUPERVISORS STRABAN TOWNSHIP
REPORT OF AMUSEMENT TAX COLLECTED
PERMIT NO._____________
NAME OF REPORTING PERMITTEE_________________________________
FOR MONTH OF__________________________________________________
NUMBER OF
PRICE OF
TOTAL
5% TAX
ADMISSIONS
ADMISSIONS
OF TOTAL
TOTAL TAX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LESS 2% COMMISSION (if paid timely) . . . . . . . . . . . . . . . . . . .
NET TAX, REMITTED HEREWITH . . . . . . . . . . . . . . . . . . . . . . .
______________________
______________________________
Date
Signature
Note: Headings may be altered to better suit the bookkeeping
method of the Permittee.
Submit one copy.

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