Sales And Use Tax Return Form - City Of Lakewood

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CITY OF LAKEWOOD
PHN 303-987-7630
SALES AND USE TAX RETURN
TDD 303-987-7057
REVENUE DIVISION
FAX 303-987-7662
PO BOX 261450
LAKEWOOD, CO 80226-9450
REVISED 10/10/06
***PLEASE DO NOT STAPLE OR TAPE ANYTHING TO THIS FORM***
TAXPAYER'S NAME AND ADDRESS
--Select One--
PERIOD:
--Select One--
DUE DATE:
LICENSE #:
(FROM LINE 4)
GROSS SALES AND SERVICE
1
5A
AMOUNT OF CITY SALES TAX :$________________________________ X3%
ADD: BAD DEBTS COLLECTED
HOTEL/MOTEL ACCOMMODATIONS TAX $_______________________ X 3%
2A
5B
(FROM LINE 3J)
TOTAL OF LINES 1 AND 2A
2B
5C
GROCERIES SUBJECT TO TAX : $______________________________ X 2%
3A
NON-TAXABLE SERVICE SALES
6
ADD: EXCESS TAX COLLECTED:
SALES TO OTHER LICENSED
TOTAL SALES TAX COLLECTED: ADD LINES 5A, 5B, 5C & LINE 6
3B
7
DEALERS FOR RESALE
SALES SHIPPED OUT OF LAKEWOOD
3C
8
BAD DEBTS CHARGED OFF
3D
9
TRADE-INS FOR TAXABLE
CITY USE TAX (FROM SCHEDULE B)
3E
RESALE
10
SALES OF GASOLINE AND
PURCHASES SUBJECT TO TAX: $_______________________________ x 3%
3F
CIGARETTES
SALES TO GOV'T, RELIGIOUS, AND
3G
11
TOTAL TAX DUE ADD LINES 7 & 10
CHARITABLE ORGANIZATIONS
IF FILED
RETURNED GOODS
10% PENALTY
3H
AFTER THE
MULTIPLY PENALTY &
12
DUE DATE
INTEREST BY LINE 11
1.4% INTEREST PER MONTH
3I
PRESCRIPTION DRUGS
ADD:
TOTAL TAX, PENALTY, AND INTEREST DUE
GROCERY FOOD SALES
3J
13
ADD LINES 11 AND 12
OTHER DEDUCTIONS
A. ADD: PRIOR PERIOD ADJUSTMENT
3K
14
3L
B. DEDUCT: PRIOR PERIOD ADJUSTMENT
ADD LINES 13, 14A & 14B
3
TOTAL DEDUCTIONS OF LINES 3A through 3L
TOTAL DUE AND
MAKE CHECK OR MONEY ORDER PAYABLE
15
PAYABLE
TOTAL CITY NET TAXABLE SALES & SERVICE -
TO CITY OF LAKEWOOD
4
SUBTRACT LINE 3 (TOTAL DEDUCTIONS) FROM LINE 2B
SCHEDULE B - CITY USE TAX
SCHEDULE C - CONSOLIDATED ACCOUNTS
This schedule is required in all cases in which the taxpayer files a consolidated return which includes sales made at more than one
The Lakewood Municipal Code imposes a tax upon the privilege of using, storing, or otherwise consuming tangible property or
location. It must be completely filled out and convey all information required in accordance with the column headings. If additional
taxable services purchased, rented or leased in the City of Lakewood.
space is needed attach schedule in same format.
DATE OF
PERIODS NET TAXABLE
NAME OF VENDOR & ADDRESS
TYPE OF COMMODITY PURCHASED
PURCHASE PRICE
ACCOUNT NUMBER
BUSINESS ADDRESS
PERIODS TOTAL GROSS SALES
PURCHASE
SALES
LINE 10
LINE 1
LINE 4
TOTAL PURCHASE PRICE OF PROPERTY/SERVICE SUBJECT TO CITY USE TAX ENTER TOTAL
ENTER TOTAL HERE AND ABOVE ON
HERE AND ABOVE ON LINE 10
LINE 1 AND 4
NOTES
1. If ownership has changed, give date of change and new
SHOW CHANGE OF OWNERSHIP, NAME AND/OR ADDRESS, ETC
I HEREBY CERTIFY UNDER PENALTY OF PERJURY, THAT THE
owners name.
NEW BUSINESS DATE
STATEMENTS MADE HEREIN ARE TO THE BEST OF MY KNOWLEDGE,
TRUE AND CORRECT.
MO
DATE
YEAR
BUSINESS ADDRESS
MAILING ADDRESS
2. If business has been permanently terminated, give
termination date.
__________________________________
SIGN
3. If business location has changed give new address.
__________________________________
TERMINATION DATE
PHONE:
MO
DATE
YEAR
4. If this return includes sales for more than one location,
__________________________________
TITLE:
complete schedule "C". Totals from Consolidated breakdown in
schedule "C" need to be the same as line 1 and line 4 of the
DATE:
return.
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