Communications Users Tax Statement - City Of Los Angeles
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1
2FOR OFFICE USE ONLY
CITY OF LOS ANGELES
________________________
PROCESSED BY:
________________________
PAYMENT DATE:
CITY OF LOS ANGELES
Care of:
Legal Name:
Business Address:
Mailing Address:
PLEASE FOLD SO THAT LOWER CITY OF LOS ANGELES ADDRESS SHOWS THROUGH RETURN ENVELOPE WINDOW
COMMUNICATIONS USERS TAX STATEMENT
ACCOUNT NUMBER
FUND/CLASS CODE
PERIOD
OUT OF BUSINESS DATE
DATE DUE
DELINQUENT AFTER
PLEASE COMPLETE THE FOLLOWING TAX INFORMATION. THE TAX RATE IS 9% OF THE TAXABLE CHARGES.
$
1. Enter intrastate taxable charges for the period indicated above.
$
2. Enter interstate/international taxable charges for the period indicated above.
$
3. Enter other taxable charges for period shown above.
$
4. *Enter total taxable charges for the period indicated above (sum of line 1, 2, and 3).
(BASIS FOR TAX)
$
5. Multiply Line 4 by 9% (0.09)
$
6. Enter interest, if delinquent (see the second page).
$
7. Enter penalty, if delinquent (see the second page).
$
8. Enter total tax, interest and penalty due (the sum of lines 5, 6 and 7).
PAY THIS AMOUNT
*Must include, but is not limited to: usage charges for VoIP, Private Communications Services (such as T-1 lines), custom calling features, text messaging,
instant messaging, ancillary services, prepaid and post-paid services, paging services and 800 services as well as other covered charges such as monthly
service fees, feature charges, equipment rentals, deaf trust surcharges, State PUC users fees, Universal Life Trust Fund, late payment charges, and charges for
non-taxable services billed together with taxable services.
PLEASE MAKE A COPY OF YOUR COMPLETED FORM FOR YOUR RECORDS. RETURN ORIGINAL WITH YOUR PAYMENT.
Payment by:
Check
Money Order
MasterCard
Visa
Discover
American Express
ACH
**No Split Payments**
Name on Card (Print) _____________________________________
Acct # _________________________________
Exp Date_ _ - _ _ _ _
Amount Paid $____________________
Authorized Signature____________________________________________
Date __________________
Billing Address of Cardholder ________________________________________________________________________
Zip Code _______________
Payments of $50,000 or more require ACH (see reverse)
Auth. #-___________________
Date Keyed _____________
--For office use only--
Your check or money order must be drawn on United States banks only.
MAKE CHECK OR MONEY ORDER PAYABLE TO: Office of Finance, City of Los Angeles
Please write your account number on your payment.
I DECLARE, UNDER PENALTY OF PERJURY UNDER THE
SIGNATURE
DATE
LAWS OF THE STATE OF CALIFORNIA THAT TO THE BEST
OF MY KNOWLEDGE THE FOREGOING IS TRUE AND
(
)
CORRECT.
TITLE
DAYTIME PHONE
IF THERE HAS BEEN A NAME, ADDRESS, OR OWNERSHIP CHANGE, PLEASE COMPLETE THE SECOND PAGE AND THE FORM
ABOVE, COMPUTE THE TAX AND RETURN THE FORM TO THIS OFFICE WITH YOUR PAYMENT. IF THIS BUSINESS ACTIVITY HAS
BEEN DISCONTINUED, PLEASE COMPLETE THE FORM.
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