Utility Users Tax Statement Form - San Francisco Tax Collector
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2SAN FRANCISCO TAX COLLECTOR
UTILITY USERS TAX STATEMENT
BUSINESS TAX SECTION
P.O. BOX 7425
SAN FRANCISCO, CA 94120-7425
TELEPHONE: (415) 554-4400
GEORGE PUTRIS, TAX ADMINISTRATOR
CERTIFICATE NUMBER
PERIOD COVERED
DUE ON OR BEFORE
TAX PERIOD
FILL IN ALL SERVICES PROVIDED
Telephone
Electricity
Communication Services
Land Line
Gas
Wireless
Steam
Water
VOIP
Date closed/sold (mm/dd/yyyy)
Final Statement
/
/
If sold, name, address, and phone number of new owner:
____________________________________
FORM MUST BE SIGNED TO BE VALID
___________________________
PLEASE PRINT NEATLY OR TYPE INSIDE THE BOXES USING BLACK INK
.
Total Charges for Reporting Period
$
1.
Exempt Charges
Residential Services/Customers
.
$
2.
2A.
(see Instructions)
(BTRC Secs 701(d), 707.1)
.
$
2B.
Utility Service Suppliers
.
2C.
Other Exempt Charges
$
.
$
Total Exempt Charges. Add Lines 2A, 2B, and 2C
3.
.
4.
Taxable charges: Subtract Line 3 from Line 1
$
.
Utility Users Tax Due: Multiply Line 4 by Rate Factor of 0.075 (see instructions)
5.
$
.
6.
Late Filing Penalty: Add $100.00 if delinquent (see instructions)
$
Late Payment Penalty: If delinquent, multiply Line 5 by 5% per month up to 20%, plus
.
7.
$
an additional 20% on the first day of the 4th month of delinquency (see instructions)
.
8.
$
Interest: Multiply Line 5 by 1% per month if delinquent (see instructions)
Administrative Fee: If filed or postmarked after
add $55.00
.
$
9.
(see instructions)
.
$
Total Payment Due: Add Line 5 through Line 9. Make check payable to the SF Tax Collector
10.
I hereby certify under penalty of perjury that I am the authorized representative of this service supplier and I have examined the foregoing utility users tax statement including any
accompanying schedules and worksheets, and the information thereon is to the best of my knowledge and belief, true, correct, and fully compliant with all of the requirements for
service providers of utility services provided in Articles 6 and 10 of the San Francisco Business and Tax Regulations Code. (Go to , click on Most Requested, then to
Municipal Codes.) I understand this statement constitutes a Request for Financial Information pursuant to Section 6.5-1 of the San Francisco Business and Tax Regulations Code,
that I am required by law to complete this statement in its entirety and that this statement is subject to audit, including a requirement to provide substantiating documentation.
UUTpdf
X
SIGN HERE
DATE
40271
PRINT NAME
BUSINESS TELEPHONE #
TITLE
EMAIL ADDRESS
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