Ez Form - Payroll Tax Statement - 2004
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2004 EZ FORM PAYROLL TAX STATEMENT
DELINQUENT AFTER FEBRUARY 28, 2005
BUSINESS TAX ID NUMBER
CERTIFICATE NUM BER
TAX YEAR
BUSINESS LOCATION
2004
DO NOT WRITE IN PRE-PRINTED AREAS. USE BLACK INK AND STAY INSIDE BOXES.
PLEASE HAND PRINT. DO NOT TYPE. DO NOT SEND PHOTOCOPY.
Number of employees
Final Statement
Date closed/sold___________
as of 12/31/04:
If sold, name, address, and phone number of new owner:
Neighborhood Beautification Fund Designation
___________________________________
___________________________________
(_______)___________________________
Complete this form only if your 2004 taxable
San Francisco payroll was $66,666.67 or
more, or you are claiming a refund.
Otherwise, complete and return the
Business Registration Renewal only.
-
-
BUSINESS TELEPHONE NUMBER
,
,
,
.
$
Total PAYROLL EXPENSE
1.
,
,
,
$
.
2.
Total EXEMPT PAYROLL
$
Total Taxable San Francisco Payroll (Subtract line 2 from line 1)
3.
,
,
,
.
4.
$
Payroll Tax Calculated (Multiply line 3 by Payroll Tax rate of 1.5% or .015)
If line 4 is less than $1,000.00.
Do not complete this form unless claiming a refund. Complete and return the Registration Renewal only.
5.
$
6.
If line 4 is over $2,500.00 enter the amount from line 4, otherwise, enter zero, and complete lines 7 to 14.
$
7.
Enter 2004 PREPAYMENT PAID (Do not include Registration Fees). If none, enter zero.
$
8.
Amount you owe. (Subtract line 7 from line 6. If line 7 is larger than line 6, enter zero).
,
,
$
.
9.
Amount to be refunded to you.
(If line 7 is larger than line 6, enter difference). See instructions.
$
10.
LATE FILING PENALTY. If filed or postmarked after February 28, 2005, enter penalty amount. See instructions.
$
11.
LATE PAYMENT PENALTY. If paid after February 28, 2005, enter late payment penalty. See instructions.
$
INTEREST. If paid after February 28, 2005, enter interest. See instructions.
12.
$
13.
ADMINISTRATIVE FEE. If filed or postmarked after February 28, 2005, enter fee of $35.00.
14.
TOTAL AMOUNT YOU OWE.
(Add Lines 8,10,11,12,13). Make check payable to San Francisco Tax Collector.
$
Under the laws of the State of California, I declare under penalty of perjury that I have read the foregoing and that it is true,
41285
correct, and complete to the best of my knowledge and belief.
X
DATE
B143-04
SIGN HERE
THIS STATEMENT MUST BE FILED BY FEBRUARY 28, 2005 OR YOU WILL BE SUBJECT TO FEES, PENALTIES, AND/OR INTEREST.
PLEASE DO NOT TEAR APART HERE
SAN FRANCISCO TAX COLLECTOR
2004 EZ
BUSINESS TAX SECTION
P.O. BOX 7425
SAN FRANCISCO, CA 94120-7425
PAYROLL TAX STATEMENT
TAXPAYER ASSISTANCE: (415) 554-4400 TTY: (415) 554-4455
PERIOD COVERED:
January 1 - December 31, 2004
DELINQUENT IF PAID OR POSTMARKED AFTER FEBRUARY 28, 2005
BUSINESS TAX ID NUMBER
OWNERSHIP NAME
PAYMENT ENCLOSED
NOTE: Payment enclosed must equal the amount stated on Line 14.
(Please write your Business Tax ID or certificate number on your check.)
OVER
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