Prepared Food & Beverage Tax Form - City Of Suffolk

CITY OF SUFFOLK

PREPARED FOOD & BEVERAGE TAX

THOMAS A. HAZELWOOD

PAY BY ______________ TO AVOID PENALTY

COMMISSIONER OF THE REVENUE

PO BOX 1459

ACCOUNT #

SUFFOLK VA 23434

(757) 514-4261

TAX PERIOD

GROSS RECEIPTS

$

CITY TAX 6.5%

$

PENALTY

$

NAME :

TOTAL DUE

$

TRADE :

MAILING ADDRESS :

CHECKS PAYABLE TO TREASURER-CITY OF SUFFOLK

I d o s w e a r t h a t t h e f i g u r e s a r e t r u e t o t h e b e s t o f m y k n o w l e d g e . S I G N A T U R E : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D A T E _ _ _ _ _ _ _ _ _ _ _