Report Of Tax Collected Upon The Sale Of Food & Beverage For Immediate Consumption

Report Of Tax Collected Upon The Sale Of Food & Beverage For Immediate Consumption - 2002

CITY OF URBANA

REPORT OF TAX COLLECTED UPON THE SALE OF FOOD & BEVERAGE

FOR IMMEDIATE CONSUMPTION

CITY OF URBANA BUSINESS ACCOUNT #

STATE OF ILLINOIS REGISTRATION #____________

BUSINESS NAME

________________________________

_____________________________

MAILING ADDRESS

_____________________________

BUSINESS ADDRESS

(If Different From Above)

_____________________________

THIS FORM FILED FOR PERIOD BEGINNING ___________________AND ENDING ___________________

1. SALES OF PREPARED FOOD FOR IMMEDIATE CONSUMPTION AND

CERTAIN ALCOHOLIC BEVERAGES:

1______________________________

(Do not include any taxes; should agree with Line 3 St-1)

2. DEDUCTIONS:

A. Receipts Not Subject to Food and

Beverage Tax (General Merchandise,

A____________________

Grocery)

B. Sales Outside City of Urbana

B____________________

C. Amounts Purchased by Employees

At Cafeterias

C____________________

D. Purchases by Patients at Hospitals

Or Residential Care Units

D____________________

E. Alcoholic Beverages NOT CONSUMED

ON PREMISES

E____________________

TOTAL DEDUCTIONS: (SUM A through D)

2______________________________

3. NET TAXABLE SALES:(Line 1 less Line 2)

3______________________________

4. FOOD/BEVERAGE TAX:(Line 3 multiplied by .005)

4______________________________

5. PENALTY: ADD penalty of 2% per month, or portion thereof, if filed late

5______________________________

(Payment is due within thirty days of reporting period)

6. TOTAL PAYMENT DUE: (SUM Lines 4 and 5)

6______________________________

Please make checks payable to “CITY OF URBANA” and mail your payment and return to 400 South Vine Street,

Urbana, Illinois 61801.

Under penalty, as provided by law, I declare that I have examined this return and to the best of my knowledge and

belief, it is true and correct.

_______________________________ ____________________________________ _____________________

Date

Signature/Title

Phone Number

Typed or Printed Signature & Title _______________________________________________________________

(2/02)

Check #

Date Deposited

Report Of Tax Collected Upon The Sale Of Food & Beverage For Immediate Consumption - 2002

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