Monthly Remittance Report - County Of Alameda
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1COUNTY OF ALAMEDA - UNINCORPORATED AREAS
UTILITY USER TAX – ORDINANCE CHAPTER 2.12
MONTHLY REMITTANCE REPORT
RETURN FOR THE PERIOD OF: ___________________________________ Due Date: _______________
COMPANY INFORMATION
Make Remittance Payable to:
Name:
ALAMEDA COUNTY TAX COLLECTOR
Mailing Address:
Address:
___________________________
COUNTY OF ALAMEDA
TREASURER-TAX COLLECTOR’S OFFICE
___________________________
BUSINESS LICENSE TAX UNIT
____________ ___ __________
224 W. WINTON AVENUE, ROOM 169
City
State
Zip Code
HAYWARD, CA 94544-1221
Federal Tax ID:
__ __ __ - __ __ - __ __ __ __
Telephone: (510) 670-6400
Telephone No:
THE AMOUNT OF UTILITY USER TAX COLLECTED BY SERVICE SUPPLIER IN ONE MONTH SHALL
BE REMITTED BY U.S. MAIL TO THE ALAMEDA COUNTY TAX COLLECTOR, POSTMARKED ON OR
BEFORE THE LAST DAY OF THE FOLLOWING MONTH. (Sections 2.12.070, 080, 090)
1. ENTER TOTAL UTILITY CHARGES BILLED TO TAXPAYERS:
$
2. UTILITY USER TAX (6.5% of Line 1):
$
3. LESS ADJUSTMENT: (Please attach proof)
A. Customers refusing to pay
$
B. Refund paid
$
C. Other (explain)
$
4. TOTAL ADJUSTMENTS: (Line 3A + 3B + 3C)
$
5. TOTAL TAX: (Line 2 minus Line 4)
$
6. PENALTY/INTEREST FOR LATE REMITTANCE:
$
A. 5%, penalty due on the date remittance first became delinquent
B. Additional 20% penalty if tax is remitted ten (10) working days after
$
delinquent date
C. Additional 1.5% interest per month or portion thereof, inclusive of penalty,
$
from the date remittance first became delinquent until paid in full
7. NET REMITTANCE: (Tax, Penalty & Interest)
$
Please attach list of names and addresses of those service users who have refused to pay the tax.
Indicate the amount owed by each user.
I hereby certify under penalty of perjury that the information provided in this Utility User Tax
Remittance Report is true and complete.
Contact Person __________________________________________Telephone No. ___________________________
Authorized Signature _____________________Full Name & Title ______________________Date Signed ________
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